MEDICARE: THE NECK STEP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	705	LA

General Provider Information

NPI Number	:	1083979330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NECK STEP, LLC

Provider Business Mailing Address
First Line	:	2920 KNIGHT ST
Second Line	:	BUILDING 1, SUITE 115
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2412
Country	:	US
Telephone Number	:	318-364-8227
Fax Number	:	318-798-1179

Provider Business Practice Location Address
First Line	:	2920 KNIGHT ST
Second Line	:	BUILDING 1, SUITE 115
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2412
Country	:	US
Telephone Number	:	318-364-8227
Fax Number	:	318-798-1179

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DONALD WAYNE LABORDE
Credential	:	D.C., F.A.C.O.
Telephone Number	:	318-364-8227

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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Directions to “THE NECK STEP, LLC ” Practice Location

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