Provider Demographics
NPI:1285149559
Name:HOUSTON CHIROPRACTIC LLC
Entity type:Organization
Organization Name:HOUSTON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-840-8274
Mailing Address - Street 1:7468 LEE DAVIS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3678
Mailing Address - Country:US
Mailing Address - Phone:804-840-8274
Mailing Address - Fax:
Practice Address - Street 1:7468 LEE DAVIS RD STE 1
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3678
Practice Address - Country:US
Practice Address - Phone:804-840-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty