Provider Demographics
NPI:1891806618
Name:L G BREEDLOVE, PLLC
Entity Type:Organization
Organization Name:L G BREEDLOVE, PLLC
Other - Org Name:LARRY G BREEDLOVE, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-327-2921
Mailing Address - Street 1:3839 BEE CAVE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5318
Mailing Address - Country:US
Mailing Address - Phone:512-327-2921
Mailing Address - Fax:512-327-4944
Practice Address - Street 1:3839 BEE CAVE RD STE 202
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5318
Practice Address - Country:US
Practice Address - Phone:512-327-2921
Practice Address - Fax:512-327-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty