Provider Demographics
NPI:1558412338
Name:LONESTAR CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:LONESTAR CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HIGBEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-434-4555
Mailing Address - Street 1:309 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4747
Mailing Address - Country:US
Mailing Address - Phone:801-434-4555
Mailing Address - Fax:801-434-8333
Practice Address - Street 1:309 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4747
Practice Address - Country:US
Practice Address - Phone:801-434-4555
Practice Address - Fax:801-434-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT500911-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty