Provider Demographics
NPI:1477733723
Name:LETZ, LAUREN ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:LETZ
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 1:501 CARROLL ST
Mailing Address - Street 2:STE 612
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2292
Mailing Address - Country:US
Mailing Address - Phone:817-348-8488
Mailing Address - Fax:817-348-8448
Practice Address - Street 1:501 CARROLL ST
Practice Address - Street 2:STE 612
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2292
Practice Address - Country:US
Practice Address - Phone:817-348-8488
Practice Address - Fax:817-348-8448
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8507Medicare PIN