Healthcare Provider Details

I. General information

NPI: 1871895540
Provider Name (Legal Business Name): LOUISIANA CHIROPRACTIC AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
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: 337-478-6172
  • Fax:
Mailing address:
  • Phone: 337-478-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN A MERTZ
Title or Position: OWNER/MEMBER
Credential: D.C.
Phone: 337-478-6172