Basic Information
| Provider Information | |||||||||
| NPI: | 1427429075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AXIS CHIROPRACTIC AND SPORTS REHABILITATION CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3215 E MILTON AVE | ||||||||
| Address2: | SUITES 7 & 8 | ||||||||
| City: | YOUNGSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705925546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144028963 | ||||||||
| FaxNumber: | 8883545793 | ||||||||
| Practice Location | |||||||||
| Address1: | 3215 E MILTON AVE | ||||||||
| Address2: | SUITES 7 & 8 | ||||||||
| City: | YOUNGSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705925546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373676649 | ||||||||
| FaxNumber: | 8883545793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2015 | ||||||||
| LastUpdateDate: | 10/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | WARNER | ||||||||
| AuthorizedOfficialFirstName: | MURREL | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING CLERK | ||||||||
| AuthorizedOfficialTelephone: | 3144028963 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 111N00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.