Organization
ADVANCED ORTHO REHAB, P.A.
Active
Other names
HUMAN PERFORMANCE: A WELLNESS & REHAB CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL E LISCUM D.C. (PROPRIETOR)
(337) 439-7007
Entity
Organization
Contact information
Practice address
1 LAKESHORE DR STE 1620, LAKE CHARLES, LA 70629-0104
(337) 439-7007
(337) 439-7011
Mailing address
1 LAKESHORE DR STE 1670, LAKE CHARLES, LA 70629-0114
(337) 439-7007
(337) 439-7011
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1563
LA
Other
Enumeration date
08/22/2007
Last updated
02/13/2012
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