Provider Demographics
NPI:1053479162
Name:SCHREIBER GAUTREAUX, LORI JEAN ROCHELLE (DC)
Entity Type:Individual
Prefix:MRS
First Name:LORI JEAN
Middle Name:ROCHELLE
Last Name:SCHREIBER GAUTREAUX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147
Mailing Address - Country:US
Mailing Address - Phone:903-887-4440
Mailing Address - Fax:903-887-5040
Practice Address - Street 1:302 N THIRD STREET
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147
Practice Address - Country:US
Practice Address - Phone:903-887-4440
Practice Address - Fax:903-887-5040
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
604517Medicare ID - Type Unspecified
U22478Medicare UPIN