Provider Demographics
NPI:1023565009
Name:ADVANCED MEDICAL AND CHIROPRACTIC
Entity type:Organization
Organization Name:ADVANCED MEDICAL AND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUNN-PERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-479-2057
Mailing Address - Street 1:1528 E PRIEN LAKE RD
Mailing Address - Street 2:STE B
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8978
Mailing Address - Country:US
Mailing Address - Phone:337-479-2057
Mailing Address - Fax:337-479-2099
Practice Address - Street 1:1528 E PRIEN LAKE RD
Practice Address - Street 2:STE B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8978
Practice Address - Country:US
Practice Address - Phone:337-479-2057
Practice Address - Fax:337-479-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1330111N00000X
LAMD.018335208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E45527Medicare UPIN