Provider Demographics
NPI:1427429075
Name:AXIS CHIROPRACTIC AND SPORTS REHABILITATION CLINIC LLC
Entity type:Organization
Organization Name:AXIS CHIROPRACTIC AND SPORTS REHABILITATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:MURREL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-402-8963
Mailing Address - Street 1:3215 E MILTON AVE
Mailing Address - Street 2:SUITES 7 & 8
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5546
Mailing Address - Country:US
Mailing Address - Phone:314-402-8963
Mailing Address - Fax:888-354-5793
Practice Address - Street 1:3215 E MILTON AVE
Practice Address - Street 2:SUITES 7 & 8
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5546
Practice Address - Country:US
Practice Address - Phone:337-367-6649
Practice Address - Fax:888-354-5793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty