Provider Demographics
NPI:1265675409
Name:TEXAS GONSTEAD, LLC
Entity Type:Organization
Organization Name:TEXAS GONSTEAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNESUK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-906-9986
Mailing Address - Street 1:230 N DENTON TAP ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2134
Mailing Address - Country:US
Mailing Address - Phone:972-906-9986
Mailing Address - Fax:972-906-9958
Practice Address - Street 1:230 N DENTON TAP RD
Practice Address - Street 2:SUITE 112
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2134
Practice Address - Country:US
Practice Address - Phone:972-906-9986
Practice Address - Fax:972-906-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF008545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty