BROADMOOR CHIROPRACTIC CLINIC NPI 1821122904

NPI Information

  • NPI: 1821122904
  • Provider Name: BROADMOOR CHIROPRACTIC CLINIC
  • Classification: Chiropractor - 111N00000X
  • Entity Type: Organization
  • CLIA Number: 19D1077682
  • Address: 5805 E KINGS HWY
    SHREVEPORT, LA
    ZIP 71105
  • Phone: (318) 868-5009

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NPI Details

BROADMOOR CHIROPRACTIC CLINIC is a chiropractor in Shreveport, LA. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. BROADMOOR CHIROPRACTIC CLINIC NPI is 1821122904. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5805 E KINGS HWY
SHREVEPORT, LA
ZIP 71105-303
Phone: (318) 868-5009
Fax: (318) 865-4451

The provider's authorized official is Christina Marie Randolph .
The authorized official title is Office Manager and has the following contact phone number (318) 868-5009.

The CLIA number assigned to this NPI record is 19D1077682 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/14/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111N00000XChiropractorYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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