Provider Demographics
NPI:1609212745
Name:CONCIERGE CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:CONCIERGE CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEARTIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-614-3937
Mailing Address - Street 1:3306 STANTON CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7864
Mailing Address - Country:US
Mailing Address - Phone:832-614-3937
Mailing Address - Fax:
Practice Address - Street 1:12155 SHADOW CREEK PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7289
Practice Address - Country:US
Practice Address - Phone:832-614-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty