Provider Demographics
NPI:1740374511
Name:WALD, LAWRENCE (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:WALD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9923 KIRKWREN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1027
Mailing Address - Country:US
Mailing Address - Phone:281-484-7803
Mailing Address - Fax:281-335-5706
Practice Address - Street 1:1202 NASA PKWY
Practice Address - Street 2:
Practice Address - City:NASSAU BAY
Practice Address - State:TX
Practice Address - Zip Code:77058-3304
Practice Address - Country:US
Practice Address - Phone:281-338-7246
Practice Address - Fax:281-335-5706
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU14131Medicare UPIN