MEDICARE: B TASSIN CHIROPRACTIC, 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	111N00000X	Chiropractor	1685	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1685	OTHER	LA	LOUISIANA BOARD OF CHIROPRACTIC EXAMINERS

General Provider Information

NPI Number	:	1639560097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B TASSIN CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1608 JIMMIE DAVIS HWY STE D
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4559
Country	:	US
Telephone Number	:	318-218-2072
Fax Number	:	318-584-7041

Provider Business Practice Location Address
First Line	:	1608 JIMMIE DAVIS HWY STE D
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4559
Country	:	US
Telephone Number	:	318-218-2072
Fax Number	:	318-584-7041

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	BRIAN J TASSIN
Credential	:	D.C.
Telephone Number	:	318-218-2072

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	09/14/2015

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