Provider Demographics
NPI:1790038636
Name:LAKEWAY HEALTH & WELLNESS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LAKEWAY HEALTH & WELLNESS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-605-0400
Mailing Address - Street 1:2121 LOHMANS CROSSING RD # 508
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5217
Mailing Address - Country:US
Mailing Address - Phone:512-605-0400
Mailing Address - Fax:512-605-0400
Practice Address - Street 1:2121 LOHMANS CROSSING RD # 508
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5217
Practice Address - Country:US
Practice Address - Phone:512-605-0400
Practice Address - Fax:512-605-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty