Provider Demographics
NPI:1154488864
Name:SAUCEDO, LOU JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LOU
Middle Name:
Last Name:SAUCEDO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BRICKNELL LN
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2596
Mailing Address - Country:US
Mailing Address - Phone:214-649-1408
Mailing Address - Fax:214-946-9419
Practice Address - Street 1:200 WYNNEWOOD VILLAGE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-946-7246
Practice Address - Fax:214-946-1351
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor