| Organization Name: | DIABETIC LIFE PULSE OF LOUISIANA, LLC |
| NPI Number: | 1568714442 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBORAH K ADCOCK (MEDICAL DIRECTOR) |
| Mailing Address: | 8575 Fern Ave Ste 110 Shreveport |
| State: | LA US |
| Postal Code: | 711055677 |
| Phone Number: | 3186988889 |
| Fax Number: | 3186988893 |
| NPI Enumeration Date: | 10/03/2012 |
| NPI Last Update Date: | 04/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 08006R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |