Provider Demographics
NPI:1841419843
Name:LONE STAR BACK PA
Entity Type:Organization
Organization Name:LONE STAR BACK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-943-9431
Mailing Address - Street 1:PO BOX 226656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-6656
Mailing Address - Country:US
Mailing Address - Phone:214-943-9431
Mailing Address - Fax:214-943-9407
Practice Address - Street 1:1002 MONTGOMERY ST STE 200
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2693
Practice Address - Country:US
Practice Address - Phone:214-943-9431
Practice Address - Fax:214-943-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty