Organization
SHREVEPORT CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRADY MICHAEL STIMITS D.C. (OWNER - OPERATOR)
(318) 429-9494
Entity
Organization
Contact information
Practice address
1845 LINE AVE, SHREVEPORT, LA 71101-4611
(318) 429-9494
(318) 429-9492
Mailing address
1845 LINE AVE, SHREVEPORT, LA 71101-4611
(318) 429-9494
(318) 429-9492
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1264
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4362770100
BLUE CROSS/BLUE SHIELD OF LOUISIANA
LA
Enumeration date
06/18/2008
Last updated
06/18/2008
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