Provider Demographics
NPI:1063690071
Name:STUDIO CHIRO LLC
Entity type:Organization
Organization Name:STUDIO CHIRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-626-6109
Mailing Address - Street 1:460 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6280
Mailing Address - Country:US
Mailing Address - Phone:985-778-7965
Mailing Address - Fax:
Practice Address - Street 1:1138 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-2024
Practice Address - Country:US
Practice Address - Phone:985-778-7965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty