Provider Demographics
NPI:1962623900
Name:SOUTHALL, TOBIE LANCASTER (DC)
Entity type:Individual
Prefix:DR
First Name:TOBIE
Middle Name:LANCASTER
Last Name:SOUTHALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 SOUTHLAKE CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5641
Mailing Address - Country:US
Mailing Address - Phone:214-769-9832
Mailing Address - Fax:
Practice Address - Street 1:1522 W AIRPORT FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6130
Practice Address - Country:US
Practice Address - Phone:972-253-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor