Organization
BPC MANDEVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK RICHARD DC (OWNER)
(985) 626-1671
Entity
Organization
Contact information
Practice address
1796 W CAUSEWAY APPROACH, MANDEVILLE, LA 70471-2955
(985) 626-1671
Mailing address
1796 W CAUSEWAY APPROACH, MANDEVILLE, LA 70471-2955
(985) 626-1671
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
225100000X
Physical Therapist
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/30/2020
Last updated
01/19/2021
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