MEDICARE: BACK TO BASICS 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	1537	LA

General Provider Information

NPI Number	:	1366766636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO BASICS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	212 EMILY CIR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6756
Country	:	US
Telephone Number	:	337-739-2280
Fax Number	:	337-237-3003

Provider Business Practice Location Address
First Line	:	302C HARBOR BEND BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-4383
Country	:	US
Telephone Number	:	337-739-2280
Fax Number	:	337-237-3003

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. SATIN ASHLEE PEREZ
Credential	:	D.C.
Telephone Number	:	337-739-2280

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	03/17/2010

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