Provider Demographics
NPI:1245880525
Name:SPINE, SPORTS, & REHAB CHIROPRACTIC CARE
Entity type:Organization
Organization Name:SPINE, SPORTS, & REHAB CHIROPRACTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:PENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-250-4088
Mailing Address - Street 1:1011 N AVENUE G
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3733
Mailing Address - Country:US
Mailing Address - Phone:337-250-4088
Mailing Address - Fax:
Practice Address - Street 1:1011 N AVENUE G
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3733
Practice Address - Country:US
Practice Address - Phone:337-250-4088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty