Organization
CENTRAL CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDLE BLAKE HAWTHORNE DC (OWNER)
(318) 281-0550
Entity
Organization
Contact information
Practice address
608 N MARABLE ST, BASTROP, LA 71220-3032
(318) 281-0550
(318) 283-1883
Mailing address
PO BOX 1462, BASTROP, LA 71221-1462
(318) 281-0550
(318) 283-1883
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
293
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1935395
—
LA
Enumeration date
09/21/2006
Last updated
11/08/2007
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