Healthcare Provider Details

I. General information

NPI: 1124521380
Provider Name (Legal Business Name): 100 PERCENT CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E PRIEN LAKE RD
LAKE CHARLES LA
70601-7976
US

IV. Provider business mailing address

2301 E PRIEN LAKE RD
LAKE CHARLES LA
70601-7976
US

V. Phone/Fax

Practice location:
  • Phone: 337-477-0600
  • Fax: 337-474-4935
Mailing address:
  • Phone: 337-477-0600
  • Fax: 337-474-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number StateLA

VIII. Authorized Official

Name: MS. KATHLEEN JANELLE ROUSH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 337-477-0600