=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336333277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISCOVER WELLNESS & REHAB OF ELMWOOD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2007
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5608 CITRUS BLVD SUITE I
-----------------------------------------------------
City | HARAHAN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70123-5517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-818-3800
-----------------------------------------------------
Fax | 909-752-4187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5608 CITRUS BLVD SUITE I
-----------------------------------------------------
City | HARAHAN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70123-5517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-818-3800
-----------------------------------------------------
Fax | 909-752-4187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PROVIDER
-----------------------------------------------------
Name | DR. GEORGE ARGUE PUTNAM JR.
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 504-818-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 994
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------