Provider Demographics
NPI:1144405093
Name:UNITED CHIROPRACTIC CLINIC,UPTOWN,INC
Entity type:Organization
Organization Name:UNITED CHIROPRACTIC CLINIC,UPTOWN,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-861-1600
Mailing Address - Street 1:807 S CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-1011
Mailing Address - Country:US
Mailing Address - Phone:504-861-1600
Mailing Address - Fax:504-861-1030
Practice Address - Street 1:807 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-1011
Practice Address - Country:US
Practice Address - Phone:504-861-1600
Practice Address - Fax:504-861-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19937Medicare UPIN
LA59129B240Medicare PIN