Provider Demographics
NPI:1902067457
Name:THERIOT FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:THERIOT FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:THERIOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:3373-367-6649
Mailing Address - Street 1:612 RUE DE ONETTA
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2163
Mailing Address - Country:US
Mailing Address - Phone:337-367-6649
Mailing Address - Fax:888-354-5793
Practice Address - Street 1:612 RUE DE ONETTA
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2163
Practice Address - Country:US
Practice Address - Phone:337-367-6649
Practice Address - Fax:888-354-5793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T645Medicare PIN
LAU54350Medicare UPIN