Provider Demographics
NPI:1093028516
Name:LOGAN CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:LOGAN CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-873-9355
Mailing Address - Street 1:9800 NORTH LAMAR BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4144
Mailing Address - Country:US
Mailing Address - Phone:512-873-9355
Mailing Address - Fax:512-873-8858
Practice Address - Street 1:9800 N LAMAR BLVD
Practice Address - Street 2:STE 140
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4160
Practice Address - Country:US
Practice Address - Phone:512-873-9355
Practice Address - Fax:512-873-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB12187Medicare PIN