=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063375103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUNCAN SPORT & SPINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 ABSINTHE CT STE A
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71115-3895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-562-3332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 ABSINTHE CT STE A
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71115-3895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-562-3332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM DUNCAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 318-218-4595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------