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General NPI Number Information
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NPI Number | 1760520449
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Entity Type | Organization
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Legal Business Name | NECK AND BACK CLINIC OF KINDER INC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 1ST AVE
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City | KINDER
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State | LA
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Zip | 70648
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Country | US
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Telephone | 337-738-4118
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Fax | 337-738-5604
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Provider Business Mailing Address
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Address Line | POB 910
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City | KINDER
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State | LA
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Zip | 70648
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Country | US
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Telephone | 337-738-4118
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Fax | 337-738-5604
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY LEE DAVIS
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Credential | DC
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Telephone | 337-738-4118
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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 | 986
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License Number State | LA
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