Provider Demographics
NPI:1962968958
Name:SWC WEST BATON ROUGE, LLC
Entity type:Organization
Organization Name:SWC WEST BATON ROUGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:225-924-3989
Mailing Address - Street 1:4463 HWY 1 S STE B
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-5990
Mailing Address - Country:US
Mailing Address - Phone:225-246-7915
Mailing Address - Fax:225-218-4923
Practice Address - Street 1:4463 HWY 1 S STE B
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-5990
Practice Address - Country:US
Practice Address - Phone:225-246-7915
Practice Address - Fax:225-218-4923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty