Organization Name: | ADVANCED ORTHO REHAB, P.A. |
NPI Number: | 1679766711 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SAMUEL E LISCUM (PROPRIETOR) |
Mailing Address: | 1 Lakeshore Dr Ste 1620 Lake Charles |
State: | LA US |
Postal Code: | 706290104 |
Phone Number: | 3374397007 |
Fax Number: | 3374397011 |
NPI Enumeration Date: | 08/22/2007 |
NPI Last Update Date: | 02/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 1563 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |