Dr. Ryan Bourg, DC
Chiropractor in Shreveport, LA. Individual provider (NPI-1).
NPI number1629721741
StatusActive
Last updated in NPPESDec 12, 2023
Details
- NPI
- 1629721741
- Entity type
- Individual (NPI-1)
- Name
- Dr. Ryan Bourg
- Credential
- DC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 28, 2022
- Certification date
- Dec 12, 2023
- Last updated
- Dec 12, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | 1885 | LA | Yes |
Practice location
1370 E 70th StShreveport, LA 71105-4924
Phone 318-670-3318
Mailing address
4903 Laurel LnBossier City, LA 71111-5407
Phone 985-637-2851
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