Injury Rehab Clinic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1383 Issued in LA

Legal business name

INJURY REHAB CLINIC LLC

Practice address

4700 Wichers Dr
Suite 307
Marrero, LA 70072-3041

Phone

(504) 340-8700

Fax

(504) 340-8701

NPI assigned

Sep 22, 2011

Last updated

Sep 22, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Miguel G Ridgley, D.C.

Title

Owner

Phone

(504) 340-8700

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316649600000",
    "number": "1578846887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 WICHERS DR",
            "address_2": "SUITE 307",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723041",
            "telephone_number": "504-340-8700",
            "fax_number": "504-340-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 WICHERS DR",
            "address_2": "SUITE 307",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723041",
            "telephone_number": "504-340-8700",
            "fax_number": "504-340-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INJURY REHAB CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-22",
        "last_updated": "2011-09-22",
        "status": "A",
        "authorized_official_last_name": "RIDGLEY",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-340-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "LA",
            "license": "1383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2160907",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Marrero, LA
• Providers in Marrero, LA by specialty
• Chiropractor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.