Provider Demographics
NPI:1558649285
Name:HARDIN, LEE ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ROY
Last Name:HARDIN
Suffix:
Gender:M
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 TROPHY LAKE DR
Mailing Address - Street 2:322
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5222
Mailing Address - Country:US
Mailing Address - Phone:817-430-0000
Mailing Address - Fax:817-490-5138
Practice Address - Street 1:501 TROPHY LAKE DR
Practice Address - Street 2:322
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5222
Practice Address - Country:US
Practice Address - Phone:817-430-0000
Practice Address - Fax:817-490-5138
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor