Organization
ULTIMATE PERFORMANCE SPORTS AND REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY ROSS WARD DC (OWNER)
(337) 523-0776
Entity
Organization
Contact information
Practice address
313 ALAMO ST, SUITE B, LAKE CHARLES, LA 70601-8528
(337) 523-0776
Mailing address
PO BOX 4610, LAKE CHARLES, LA 70606-4610
(337) 312-1446
(337) 312-1490
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
04/12/2012
Last updated
09/13/2012
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