Healthcare Provider Details

I. General information

NPI: 1427014299
Provider Name (Legal Business Name): JUSTIN LORENZ WALBOM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8913 BLUEBONNET BLVD STE A
BATON ROUGE LA
70810-2974
US

IV. Provider business mailing address

14917 AUDUBON LAKES DR
BATON ROUGE LA
70810-8403
US

V. Phone/Fax

Practice location:
  • Phone: 225-501-8050
  • Fax: 225-800-9120
Mailing address:
  • Phone: 256-777-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: