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General NPI Number Information
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NPI Number | 1992912380
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Entity Type | Organization
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Legal Business Name | EASTGATE CHIROPRACTIC CLINIC, INC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1520 N HEARNE AVE SUITE 103
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City | SHREVEPORT
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State | LA
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Zip | 71107-7155
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Country | US
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Telephone | 318-222-6298
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Fax | 318-222-6299
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Provider Business Mailing Address
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Address Line | 1520 N HEARNE AVE SUITE 103
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City | SHREVEPORT
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State | LA
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Zip | 71107-7155
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Country | US
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Telephone | 318-222-6298
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Fax | 318-222-6299
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DWIGHT V HART
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Credential | D.C.
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Telephone | 318-222-6297
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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 | 973
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License Number State | LA
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