Provider Demographics
NPI:1861654410
Name:BASTROP CHIROPRACTIC SPINE & INJURY CENTER
Entity Type:Organization
Organization Name:BASTROP CHIROPRACTIC SPINE & INJURY CENTER
Other - Org Name:CENTRAL CHIROPRACTIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-281-0550
Mailing Address - Street 1:608 N. MARABLE STREET
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-3032
Mailing Address - Country:US
Mailing Address - Phone:318-281-0550
Mailing Address - Fax:318-283-1883
Practice Address - Street 1:608 N. MARABLE STREET
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3032
Practice Address - Country:US
Practice Address - Phone:318-281-0550
Practice Address - Fax:318-283-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DH05Medicare PIN