Provider Demographics
NPI:1962673020
Name:J&L RELIANCE MANAGEMENT INC
Entity Type:Organization
Organization Name:J&L RELIANCE MANAGEMENT INC
Other - Org Name:PHYSICIANS DIAGNOSTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-842-1338
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77572-0937
Mailing Address - Country:US
Mailing Address - Phone:281-842-1338
Mailing Address - Fax:281-842-1794
Practice Address - Street 1:3403 SPENCER HWY
Practice Address - Street 2:A
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1107
Practice Address - Country:US
Practice Address - Phone:281-842-1338
Practice Address - Fax:281-842-1794
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J&L RELIANCE MANAGEMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6779111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097QHOtherBCBS
TXU64886Medicare UPIN