Provider Demographics
NPI:1497200109
Name:SOMA CHIRO LLC
Entity Type:Organization
Organization Name:SOMA CHIRO LLC
Other - Org Name:ROBERTS CHIROPRACTIC & ACCUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-414-1301
Mailing Address - Street 1:1404 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3306
Mailing Address - Country:US
Mailing Address - Phone:936-634-8461
Mailing Address - Fax:
Practice Address - Street 1:1404 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3306
Practice Address - Country:US
Practice Address - Phone:936-634-8461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188437101Medicaid
TX608364OtherBLUE CROSS BLUE SHIELD
TXP00607850OtherMEDICARE RAILROAD
TXP00607850OtherMEDICARE RAILROAD