Provider Demographics
NPI:1083979330
Name:THE NECK STEP, LLC
Entity Type:Organization
Organization Name:THE NECK STEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FACO
Authorized Official - Phone:318-364-8227
Mailing Address - Street 1:2920 KNIGHT ST
Mailing Address - Street 2:BUILDING 1, SUITE 115
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2412
Mailing Address - Country:US
Mailing Address - Phone:318-364-8227
Mailing Address - Fax:318-798-1179
Practice Address - Street 1:2920 KNIGHT ST
Practice Address - Street 2:BUILDING 1, SUITE 115
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2412
Practice Address - Country:US
Practice Address - Phone:318-364-8227
Practice Address - Fax:318-798-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA705261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA59154Medicare PIN