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General NPI Number Information
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NPI Number | 1114338092
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Entity Type | Organization
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Legal Business Name | ALL THE WAY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 8575 FERN AVE STE 101
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City | SHREVEPORT
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State | LA
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Zip | 71105-5677
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Country | US
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Telephone | 318-797-2587
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Fax | 318-797-2588
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Provider Business Mailing Address
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Address Line | 8575 FERN AVE STE 101
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City | SHREVEPORT
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State | LA
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Zip | 71105-5677
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Country | US
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Telephone | 318-797-2587
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Fax | 318-797-2588
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Authorized Official
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Title or Position | OWNER
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Name | JASON L MAGGIO
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Credential | D.C.
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Telephone | 318-797-2587
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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 | 1425
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License Number State | LA
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