Organization · NPI-2

Advanced Ortho Rehab, P.A.

Chiropractor · Lake Charles, LA

NPI number1679766711
StatusActive
Last updated in NPPESFeb 13, 2012

Details

NPI
1679766711
Entity type
Organization (NPI-2)
Legal business name
Advanced Ortho Rehab, P.A.
Organization subpart
No
Enumeration date
Aug 22, 2007
Last updated
Feb 13, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111N00000X Chiropractor1563LAYes

Other names

  • Human Performance: A Wellness & Rehab Center (Doing Business As)

Practice location

1 Lakeshore Dr Ste 1620
Lake Charles, LA 70629-0104

Phone 337-439-7007 · Fax 337-439-7011

Mailing address

1 Lakeshore Dr Ste 1670
Lake Charles, LA 70629-0114

Phone 337-439-7007 · Fax 337-439-7011

Authorized official

Samuel E Liscum
Proprietor
3374397007

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