Provider Demographics
NPI:1457668659
Name:LONE STAR FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:LONE STAR FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:WALDON-ROBERT
Authorized Official - Last Name:NEVELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-296-9189
Mailing Address - Street 1:24124 CINCO VILLAGE CENTER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8396
Mailing Address - Country:US
Mailing Address - Phone:770-296-9189
Mailing Address - Fax:
Practice Address - Street 1:24124 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8396
Practice Address - Country:US
Practice Address - Phone:770-296-9189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty