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General NPI Number Information
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NPI Number | 1023565009
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL AND CHIROPRACTIC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 1528 E PRIEN LAKE RD STE B
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8978
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Country | US
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Telephone | 337-479-2057
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Fax | 337-479-2099
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Provider Business Mailing Address
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Address Line | 1528 E PRIEN LAKE RD STE B
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8978
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Country | US
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Telephone | 337-479-2057
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Fax | 337-479-2099
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LAUREN E DUNN-PERRIN
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Credential |
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Telephone | 337-479-2057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1330
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD.018335
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License Number State | LA
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