Provider Demographics
NPI:1609040211
Name:SPINAL HEALTH CENTER OF NORTH LOUISIANA LLC
Entity Type:Organization
Organization Name:SPINAL HEALTH CENTER OF NORTH LOUISIANA LLC
Other - Org Name:HEALTHSOURCE CHIROPRACTIC OF NORTH LOUISIANA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STEFFINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-322-2250
Mailing Address - Street 1:3103 CYPRESS ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5270
Mailing Address - Country:US
Mailing Address - Phone:318-322-2250
Mailing Address - Fax:318-322-1114
Practice Address - Street 1:3103 CYPRESS ST
Practice Address - Street 2:STE 4
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5269
Practice Address - Country:US
Practice Address - Phone:318-322-2250
Practice Address - Fax:318-322-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty