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General NPI Number Information
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NPI Number | 1134510167
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Entity Type | Organization
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Legal Business Name | JOLIE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 1210 E MCNEESE ST
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City | LAKE CHARLES
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State | LA
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Zip | 70607-4756
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Country | US
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Telephone | 337-502-5303
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 E MCNEESE ST
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City | LAKE CHARLES
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State | LA
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Zip | 70607-4756
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TREVOR C JOLIE
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Credential | DC
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Telephone | 337-502-5303
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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 | 1680
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License Number State | LA
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