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General NPI Number Information
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NPI Number | 1255655239
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Entity Type | Organization
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Legal Business Name | REJUVENATE HEALTH CHIROPRACTIC
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Dates
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Enumeration Date | 03/20/2010
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Last Update Date | 03/20/2010
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Provider Practice Location Address
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Address Line | 751 BAYOU PINES EAST DR SUITE R
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City | LAKE CHARLES
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State | LA
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Zip | 70601-7196
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Country | US
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Telephone | 337-802-6497
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 E BELT LINE RD APT 924
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City | COPPELL
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State | TX
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Zip | 75019-4231
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Country | US
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Telephone | 337-802-6497
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Fax | 972-947-3992
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. ATHENA MARIE PAYNE
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Credential | D.C.
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Telephone | 337-802-6497
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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 | 1556
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License Number State | LA
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