Provider Demographics
NPI:1053630327
Name:SOUTHLAKE HEALTH P.C.
Entity Type:Organization
Organization Name:SOUTHLAKE HEALTH P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-310-6604
Mailing Address - Street 1:100 W SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE # 410
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6100
Mailing Address - Country:US
Mailing Address - Phone:817-310-6604
Mailing Address - Fax:817-310-6478
Practice Address - Street 1:100 W SOUTHLAKE BLVD
Practice Address - Street 2:SUITE # 410
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6100
Practice Address - Country:US
Practice Address - Phone:817-310-6604
Practice Address - Fax:817-310-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty