Provider Demographics
NPI:1508256207
Name:LUBBOCK INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:LUBBOCK INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF LUBBOCK INTEGRATIVE MEDICI
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:GAFFORD
Authorized Official - Suffix:II
Authorized Official - Credentials:LAC, MACOM
Authorized Official - Phone:806-797-7653
Mailing Address - Street 1:3711 20TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3711 20TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1223
Practice Address - Country:US
Practice Address - Phone:806-797-7653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX01569171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty