Provider Demographics
NPI:1770532749
Name:ADVANCED MEDICAL & DIAGNOSTIC CENTER
Entity type:Organization
Organization Name:ADVANCED MEDICAL & DIAGNOSTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:F
Authorized Official - Last Name:BARNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-479-2057
Mailing Address - Street 1:1528 E. PRIEN LAKE RD.,
Mailing Address - Street 2:STE. B
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-479-2057
Mailing Address - Fax:337-479-2099
Practice Address - Street 1:1528 E. PRIEN LAKE RD.,
Practice Address - Street 2:STE. B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-479-2057
Practice Address - Fax:337-479-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAE45527Medicare UPIN
LA5X159Medicare ID - Type Unspecified