Healthcare Provider Details

I. General information

NPI: 1154513273
Provider Name (Legal Business Name): SPINAL INNOVATIONS & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 FERN AVE SUITE 303
SHREVEPORT LA
71105-4971
US

IV. Provider business mailing address

7330 FERN AVE SUITE 303
SHREVEPORT LA
71105-4971
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-5557
  • Fax: 318-798-5558
Mailing address:
  • Phone: 318-798-5557
  • Fax: 318-798-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberLA1117
License Number StateLA

VIII. Authorized Official

Name: DR. JOHN ALLEN THOMPSON
Title or Position: CHIROPRACTIC PHYSICIAN, PRESIDENT
Credential: DC
Phone: 318-798-5557