Provider Demographics
NPI:1417355330
Name:LACOMBE CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:LACOMBE CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LACOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-676-7588
Mailing Address - Street 1:3401 ROYAL VISTA BLVD, UNIT B #102
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1149
Mailing Address - Country:US
Mailing Address - Phone:512-676-7588
Mailing Address - Fax:
Practice Address - Street 1:3401 ROYAL VISTA BLVD, UNIT B #102
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1149
Practice Address - Country:US
Practice Address - Phone:512-676-7588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty