Ryan Bourg, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1885 Issued in LA

Practice address

1370 E 70TH St
Shreveport, LA 71105-4924

Phone

(318) 670-3318

NPI assigned

Jan 28, 2022

Last updated

Dec 12, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Moreau Physical Therapy Inc.Group PAC ID 3173419298, 81 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Moreau Physical Therapy Inc.

  dba Moreau Physical Therapy

  • Physical Therapist
  • Baton Rouge, LA
  • NPI 1770568669

  Chiropractor

  Medicare reassignment Care Compare group NPD
• Alvin C Moreau Jr Licensed Physical Therapist DTD 01 15 82

  dba Moreau Physical Therapy

  • Physical Therapist
  • Beaumont, TX
  • NPI 1831962018
  NPD
• Alvin C Moreau Jr Licensed Physical Therapist DTD 01 15 82

  dba Moreau Physical Therapy

  • Physical Therapist
  • Baton Rouge, LA
  • NPI 1750566071
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1629721741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4903 LAUREL LN",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711115407",
            "telephone_number": "985-637-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 E 70TH ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054924",
            "telephone_number": "318-670-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURG",
        "first_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-28",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "LA",
            "license": "1885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latisha Bouldin
• Courtney Leah Bouligny, MHS
• Johanna Boult, PHD
• Thomas Andrew Bounds, PH.D.
• Walter E Bounds, MD
• Cole Bourgeois
• Dara Bourn, SSCOMH
• Candace Brooke Bourque
• Marquita Larae Boutte', PLMFT
• Jennifer Albritton Bowen, LCSW-BACS

• Chiropractor in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Chiropractor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.