Provider Demographics
NPI:1770633125
Name:BRUSTEIN, LANNY B (DC)
Entity Type:Individual
Prefix:DR
First Name:LANNY
Middle Name:B
Last Name:BRUSTEIN
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 1:2303 RR 620 S
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6219
Mailing Address - Country:US
Mailing Address - Phone:512-891-0861
Mailing Address - Fax:
Practice Address - Street 1:222 CAPRI
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4306
Practice Address - Country:US
Practice Address - Phone:512-891-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor