Provider Demographics
NPI:1265525554
Name:CLINTON, LARA (DC)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:TOBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4654 HIGHWAY 6 N
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2868
Mailing Address - Country:US
Mailing Address - Phone:281-855-2277
Mailing Address - Fax:281-855-2292
Practice Address - Street 1:4654 HIGHWAY 6 N
Practice Address - Street 2:SUITE 305
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2868
Practice Address - Country:US
Practice Address - Phone:281-855-2277
Practice Address - Fax:281-855-2292
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001741001Medicaid
TX6341OtherSTATE LICENSE
TX604068Medicare ID - Type Unspecified
TX001741001Medicaid