Healthcare Provider Details

I. General information

NPI: 1447523626
Provider Name (Legal Business Name): TOTAL HEALTH CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19548 HIGHWAY 167
DRY PRONG LA
71423-3400
US

IV. Provider business mailing address

19548 HIGHWAY 167
DRY PRONG LA
71423-3400
US

V. Phone/Fax

Practice location:
  • Phone: 318-899-3990
  • Fax: 318-899-3991
Mailing address:
  • Phone: 318-899-3990
  • Fax: 318-899-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number508
License Number StateLA

VIII. Authorized Official

Name: DR. DAVID A. BISH SR.
Title or Position: DR.
Credential: D.O.
Phone: 318-899-3990