Provider Demographics
NPI:1033241070
Name:LONE STAR CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:LONE STAR CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEITER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-599-1354
Mailing Address - Street 1:1280 HAWKINS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-4949
Mailing Address - Country:US
Mailing Address - Phone:915-599-1354
Mailing Address - Fax:915-599-1695
Practice Address - Street 1:1280 HAWKINS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-4949
Practice Address - Country:US
Practice Address - Phone:915-599-1354
Practice Address - Fax:915-599-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00935YMedicare ID - Type UnspecifiedINDIVIDUAL # 8F0260