Provider Demographics
NPI:1689964223
Name:HOUSE, JOHNATHAN NELSON (DC, LAT)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:NELSON
Last Name:HOUSE
Suffix:
Gender:M
Credentials:DC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 N FM 2528
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-4961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6203 N FM 2528
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-4961
Practice Address - Country:US
Practice Address - Phone:806-747-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11612111N00000X
TXAT4786172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No172M00000XOther Service ProvidersMechanotherapist