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General NPI Number Information
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NPI Number | 1538609193
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Entity Type | Organization
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Legal Business Name | PELICAN STATE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 805 PRAIRIE ST
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City | WINNSBORO
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State | LA
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Zip | 71295-2631
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Country | US
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Telephone | 318-237-6396
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2537
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City | MONROE
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State | LA
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Zip | 71207-2537
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Country | US
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Telephone | 318-237-6396
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JASMINE VIALIZ
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Credential |
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Telephone | 703-738-9955
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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 | 540
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License Number State | LA
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