MEDICARE: ADVANCED MEDICAL CENTER OF UPTOWN

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	1288	LA

General Provider Information

NPI Number	:	1982804217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL CENTER OF UPTOWN

Provider Business Mailing Address
First Line	:	4600 S CLAIBORNE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70125-5010
Country	:	US
Telephone Number	:	504-899-2225
Fax Number	:	504-899-2280

Provider Business Practice Location Address
First Line	:	4600 S CLAIBORNE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70125-5010
Country	:	US
Telephone Number	:	504-899-2225
Fax Number	:	504-899-2280

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	DR. PAUL GORDON JR.
Credential	:	DC
Telephone Number	:	504-899-2225

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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