Provider Demographics
NPI:1992980189
Name:CHIROPRACTIC CLINIC OF GRETNA
Entity type:Organization
Organization Name:CHIROPRACTIC CLINIC OF GRETNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CELINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DR OF CHIROPRACTIC
Authorized Official - Phone:504-392-8000
Mailing Address - Street 1:548 LAPALCO BLVD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7305
Mailing Address - Country:US
Mailing Address - Phone:504-392-8000
Mailing Address - Fax:504-392-9252
Practice Address - Street 1:548 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7305
Practice Address - Country:US
Practice Address - Phone:504-392-8000
Practice Address - Fax:504-392-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA655261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57776Medicare PIN