Provider Demographics
NPI:1891241337
Name:LACROIX, SAMUEL R (DC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:R
Last Name:LACROIX
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 1:1120 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:BLDG 1 STE 250
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6464
Mailing Address - Country:US
Mailing Address - Phone:512-258-4425
Mailing Address - Fax:512-258-4553
Practice Address - Street 1:1120 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BLDG 1 STE 250
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6464
Practice Address - Country:US
Practice Address - Phone:512-258-4425
Practice Address - Fax:512-258-4553
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13032111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician