Provider Demographics
NPI:1013360536
Name:BONE AND JOINT SPINE TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:BONE AND JOINT SPINE TREATMENT CENTER LLC
Other - Org Name:CHIROPRACTIC SPORTS AND INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-766-3031
Mailing Address - Street 1:6160 PERKINS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4191
Mailing Address - Country:US
Mailing Address - Phone:225-766-3031
Mailing Address - Fax:225-767-0045
Practice Address - Street 1:6160 PERKINS RD STE 130
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4191
Practice Address - Country:US
Practice Address - Phone:225-766-3031
Practice Address - Fax:225-767-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty