Provider Demographics
NPI:1780560862
Name:VILLAVASSO, STARR
Entity type:Individual
Prefix:DR
First Name:STARR
Middle Name:
Last Name:VILLAVASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-0326
Mailing Address - Country:US
Mailing Address - Phone:601-749-4939
Mailing Address - Fax:
Practice Address - Street 1:1300 GAUSE BLVD STE C7
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3041
Practice Address - Country:US
Practice Address - Phone:601-749-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACHIRO11366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor