MEDICARE: CHIROPRACTIC CENTER FOR PAIN AND REHABILITATION, 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	1337	LA

General Provider Information

NPI Number	:	1750331716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC CENTER FOR PAIN AND REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2146
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70602-2146
Country	:	US
Telephone Number	:	337-562-0817
Fax Number	:	337-479-2391

Provider Business Practice Location Address
First Line	:	418 E COLLEGE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-1704
Country	:	US
Telephone Number	:	337-562-0817
Fax Number	:	337-479-2391

Authorized Official
Title or Position	:	OWNER
Name	:	DONALD RAY THIGPEN II
Credential	:	DC
Telephone Number	:	337-562-0817

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/22/2009

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