Provider Demographics
NPI:1922330778
Name:LONESTAR NEURODIAGNOSTICS & REHAB
Entity Type:Organization
Organization Name:LONESTAR NEURODIAGNOSTICS & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:TOMAS
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-686-2272
Mailing Address - Street 1:3004 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6000
Mailing Address - Country:US
Mailing Address - Phone:956-686-2272
Mailing Address - Fax:
Practice Address - Street 1:110 E SAVANNAH AVE
Practice Address - Street 2:SUITE A102
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1241
Practice Address - Country:US
Practice Address - Phone:956-630-2220
Practice Address - Fax:956-630-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10209111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty