MEDICARE: DR. KALEB DESHOTEL D.C.

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	111N00000X	Chiropractor	1724	LA

General Provider Information

NPI Number	:	1093116451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALEB DESHOTEL D.C.

Provider Business Mailing Address
First Line	:	2626 COUNTRY CLUB RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5912
Country	:	US
Telephone Number	:	337-990-5497
Fax Number	:	337-990-5570

Provider Business Practice Location Address
First Line	:	2626 COUNTRY CLUB RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5912
Country	:	US
Telephone Number	:	337-990-5497
Fax Number	:	337-990-5570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/04/2014

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