Provider Demographics
NPI:1902064009
Name:GUICE CHIROPRACTIC CARE, LLC
Entity Type:Organization
Organization Name:GUICE CHIROPRACTIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DUDLEY
Authorized Official - Last Name:GUICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-683-0300
Mailing Address - Street 1:7645 PINES RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3905
Mailing Address - Country:US
Mailing Address - Phone:318-683-0300
Mailing Address - Fax:318-687-3937
Practice Address - Street 1:7645 PINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3905
Practice Address - Country:US
Practice Address - Phone:318-683-0300
Practice Address - Fax:318-687-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1811956592OtherINDIVIDUAL NPI
LAHO433OtherBLUECROSS BLUE SHIELD
LA1811956592OtherINDIVIDUAL NPI
LAHO433OtherBLUECROSS BLUE SHIELD