Healthcare Provider Details

I. General information

NPI: 1326142621
Provider Name (Legal Business Name): SHELL CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 STERLINGTON RD.
MONROE LA
71203-2519
US

IV. Provider business mailing address

3219 STERLINGTON RD.
MONROE LA
71203-2519
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-5388
  • Fax: 318-325-9882
Mailing address:
  • Phone: 318-387-5388
  • Fax: 318-325-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1002
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1397
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number805
License Number StateLA

VIII. Authorized Official

Name: GORDON G. GRANT
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 318-387-5388