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General NPI Number Information
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NPI Number | 1083979330
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Entity Type | Organization
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Legal Business Name | THE NECK STEP, LLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 2920 KNIGHT ST BUILDING 1, SUITE 115
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City | SHREVEPORT
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State | LA
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Zip | 71105-2412
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Country | US
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Telephone | 318-364-8227
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Fax | 318-798-1179
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Provider Business Mailing Address
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Address Line | 2920 KNIGHT ST BUILDING 1, SUITE 115
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City | SHREVEPORT
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State | LA
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Zip | 71105-2412
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Country | US
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Telephone | 318-364-8227
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Fax | 318-798-1179
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. DONALD WAYNE LABORDE
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Credential | D.C., F.A.C.O.
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Telephone | 318-364-8227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 705
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License Number State | LA
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