MEDICARE: REJUVENATE HEALTH CHIROPRACTIC

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	1556	LA

General Provider Information

NPI Number	:	1255655239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REJUVENATE HEALTH CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1717 E BELT LINE RD
Second Line	:	APT 924
City	:	COPPELL
State	:	TX
Zip	:	75019-4231
Country	:	US
Telephone Number	:	337-802-6497
Fax Number	:	972-947-3992

Provider Business Practice Location Address
First Line	:	751 BAYOU PINES EAST DR
Second Line	:	SUITE R
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7196
Country	:	US
Telephone Number	:	337-802-6497
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. ATHENA MARIE PAYNE
Credential	:	D.C.
Telephone Number	:	337-802-6497

Provider Enumeration Date	:	03/20/2010
Last Update Date	:	03/20/2010

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