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General NPI Number Information
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NPI Number | 1912870924
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Entity Type | Organization
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Legal Business Name | LOUISIANA BRAIN INJURY SPECIALISTS, LLC
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 401 E VEROT SCHOOL RD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3315
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Country | US
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Telephone | 337-232-3353
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Fax |
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Provider Business Mailing Address
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Address Line | 401 E VEROT SCHOOL RD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3315
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Country | US
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Telephone | 337-232-3353
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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. JACOB SCOTT CLARK
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Credential | DC
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Telephone | 337-849-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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