Healthcare Provider Details

I. General information

NPI: 1154872141
Provider Name (Legal Business Name): WELLNESS CHIROPRACTIC & HOLISTIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 MEDORA ST
LAKE CHARLES LA
70601-1203
US

IV. Provider business mailing address

2121 LAKE ST
LAKE CHARLES LA
70601-7103
US

V. Phone/Fax

Practice location:
  • Phone: 337-602-1348
  • Fax: 337-602-1350
Mailing address:
  • Phone: 337-433-1919
  • Fax: 337-433-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1603
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number1603
License Number StateLA

VIII. Authorized Official

Name: DR. JOSHUA THOMAS
Title or Position: CHIROPRACTOR/ OWNER
Credential: D.C.
Phone: 337-433-1919