Provider Demographics
NPI:1689719973
Name:NECK AND BACK INSTITUTE OF SWLA, INC.
Entity Type:Organization
Organization Name:NECK AND BACK INSTITUTE OF SWLA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:THERIOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-433-7551
Mailing Address - Street 1:730 BAYOU PINES EAST DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7184
Mailing Address - Country:US
Mailing Address - Phone:337-433-7551
Mailing Address - Fax:337-433-6378
Practice Address - Street 1:730 BAYOU PINES EAST DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7184
Practice Address - Country:US
Practice Address - Phone:337-433-7551
Practice Address - Fax:337-433-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1652954Medicaid
U50725Medicare UPIN
LA1652954Medicaid