Provider Demographics
NPI:1871627547
Name:DR SUZANNE P DARDEAU A COMMUNITY CHIROPRACTIC CORP
Entity type:Organization
Organization Name:DR SUZANNE P DARDEAU A COMMUNITY CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DARDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-989-8568
Mailing Address - Street 1:2801 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7181
Mailing Address - Country:US
Mailing Address - Phone:337-989-8568
Mailing Address - Fax:337-989-7036
Practice Address - Street 1:2801 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7181
Practice Address - Country:US
Practice Address - Phone:337-989-8568
Practice Address - Fax:337-989-7036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1956147Medicaid
LA5S779Medicare ID - Type Unspecified
LA1956147Medicaid