Provider Demographics
NPI:1518066182
Name:LOGAN, DEBORA (LAT, ATC, DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LAT, ATC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 N LAMAR BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4144
Mailing Address - Country:US
Mailing Address - Phone:512-873-9355
Mailing Address - Fax:512-873-8858
Practice Address - Street 1:9800 N LAMAR BLVD STE 140
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4144
Practice Address - Country:US
Practice Address - Phone:512-873-9355
Practice Address - Fax:512-873-8858
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017824-01Medicaid
TX0017824-01Medicaid
TXTXB121288Medicare PIN