Provider Demographics
NPI:1366692535
Name:CAPITOL SPINE AND REHABILITATION
Entity Type:Organization
Organization Name:CAPITOL SPINE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ORSEN
Authorized Official - Last Name:BELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:225-926-1900
Mailing Address - Street 1:429 E AIRPORT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4844
Mailing Address - Country:US
Mailing Address - Phone:226-926-1900
Mailing Address - Fax:225-926-1901
Practice Address - Street 1:429 E AIRPORT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4844
Practice Address - Country:US
Practice Address - Phone:226-926-1900
Practice Address - Fax:225-926-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1307111N00000X
LA1441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6397510001Medicare NSC