Provider Demographics
NPI:1679963177
Name:BG4G LLC
Entity type:Organization
Organization Name:BG4G LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICHIARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-232-4562
Mailing Address - Street 1:23482 JUDITH ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-8430
Mailing Address - Country:US
Mailing Address - Phone:504-321-0411
Mailing Address - Fax:504-321-0412
Practice Address - Street 1:110 VETERANS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3027
Practice Address - Country:US
Practice Address - Phone:504-321-0411
Practice Address - Fax:504-321-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty