Provider Demographics
NPI:1689721631
Name:SOUDER, GERRI LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:GERRI LYN
Middle Name:
Last Name:SOUDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 BRETT RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-1613
Mailing Address - Country:US
Mailing Address - Phone:972-333-3477
Mailing Address - Fax:214-206-8804
Practice Address - Street 1:3005 BRETT RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-1613
Practice Address - Country:US
Practice Address - Phone:972-333-3477
Practice Address - Fax:214-206-8804
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor