Provider Demographics
NPI:1992884936
Name:KILLEN, DAVID L (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:KILLEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 ONTARIO AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-2612
Mailing Address - Country:US
Mailing Address - Phone:985-735-1112
Mailing Address - Fax:985-735-1386
Practice Address - Street 1:521 ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-2612
Practice Address - Country:US
Practice Address - Phone:985-735-1112
Practice Address - Fax:985-735-1386
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2127390Medicaid
LA2127390Medicaid