Organization
DYNAMIC SPINAL IMAGING OF SWLA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN R CONDOS PHD (PRESIDENT)
(337) 602-6300
Entity
Organization
Contact information
Practice address
805 W BAYOU PINES DR, SUITE D, LAKE CHARLES, LA 70601-9605
(337) 602-6300
(337) 602-6339
Mailing address
805 W BAYOU PINES DR, SUITE D, LAKE CHARLES, LA 70601-9605
(337) 602-6300
(337) 602-6339
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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