Advanced Ortho Rehab, P.a.
Organization Active NPI Chiropractor · Lake Charles, LA
NPI 1679766711 · NPPES record last updated Feb 13, 2012
Key facts
- NPI
- 1679766711
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1563 (LA)
- Legal business name
- ADVANCED ORTHO REHAB, P.A.
- Practice address
- 1 Lakeshore Dr Ste 1620
Lake Charles, LA 70629-0104 - Phone
- (337) 439-7007
- Fax
- (337) 439-7011
- NPI assigned
- Aug 22, 2007
- Organization subpart
- No
Authorized official
- Name
- Samuel E Liscum, D.C.
- Title
- Proprietor
- Phone
- (337) 439-7007
Practitioners 1
-
Samuel E Liscum, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110621000757 | LA | Part B Supplier - Clinic/Group Practice | 6507930724 |
Receives reassigned benefits from 1 practitioner Practice locations: Sulphur, LA |
National Provider Directory
Locations
1 Lakeshore Dr
Ste 1620
Lake Charles, LA 70629
Phone (337) 421-1510
709 Ryan St
Lake Charles, LA 70601
Phone (337) 439-7007
1 Lakeshore Dr
Ste 1670
Lake Charles, LA 70629
Phone (337) 439-7007
2412 Maplewood Dr
Ste 2
Sulphur, LA 70663
Phone (337) 439-7007
9521 FM 1097 Rd W
Willis, TX 77318
Phone (936) 856-8470
9521 FM 1097 Rd W
Ste C
Willis, TX 77318
Phone (936) 856-8470
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 1563 | LA | Yes |
Addresses
Primary practice location
1 Lakeshore Dr Ste 1620
Lake Charles, LA 70629-0104
Mailing address
1 Lakeshore Dr Ste 1670
Lake Charles, LA 70629-0114
Phone (337) 439-7007
Other names
- HUMAN PERFORMANCE: A WELLNESS & REHAB CENTER
Other providers in Lake Charles, LA
- Wasilat A Adeoluwa
- Anthony K Adeosun
- Advanced Medical & Diagnostic Center
- Advanced Medical and Chiropractic
- Advanced Medical Equipment and Supplies, LLC
- Advanced Personal Care
- Advanced Personal Care
- Advanced Personal Care LLC
- Advanced Personal Care, LLC
- Advanced Psychiatric Services, LLC
All providers in Lake Charles, LA · Chiropractor in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.