Provider Demographics
NPI:1902027824
Name:RODDICK, LAWRENCE (DC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:RODDICK
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 1:9503 KEITH ANTHONY
Mailing Address - Street 2:94 BRIGGS STE 150
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4160
Mailing Address - Country:US
Mailing Address - Phone:210-921-0265
Mailing Address - Fax:210-922-9679
Practice Address - Street 1:94 BRIGGS ST STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1206
Practice Address - Country:US
Practice Address - Phone:210-921-0265
Practice Address - Fax:210-922-9679
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 6109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor