Provider Demographics
NPI:1356730352
Name:LSSR MANAGEMENT INC
Entity type:Organization
Organization Name:LSSR MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SORUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-975-4645
Mailing Address - Street 1:PO BOX 47626
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-8626
Mailing Address - Country:US
Mailing Address - Phone:847-975-4645
Mailing Address - Fax:
Practice Address - Street 1:13777 JUDSON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-4514
Practice Address - Country:US
Practice Address - Phone:847-975-4645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX12285111NR0400X, 111NX0100X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty