Provider Demographics
NPI:1346528635
Name:TOLOUE, SORAYYA S (DC)
Entity Type:Individual
Prefix:
First Name:SORAYYA
Middle Name:S
Last Name:TOLOUE
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 1:180 GRANITE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4516
Mailing Address - Country:US
Mailing Address - Phone:512-291-3735
Mailing Address - Fax:
Practice Address - Street 1:2100 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4881
Practice Address - Country:US
Practice Address - Phone:512-291-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor