Healthcare Provider Details

I. General information

NPI: 1366930208
Provider Name (Legal Business Name): 633 CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N GRAY ST # B
KILLEEN TX
76541-5245
US

IV. Provider business mailing address

308 N GRAY ST # B
KILLEEN TX
76541-5245
US

V. Phone/Fax

Practice location:
  • Phone: 225-522-1380
  • Fax: 888-620-8147
Mailing address:
  • Phone: 225-522-1380
  • Fax: 888-620-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13635
License Number StateTX

VIII. Authorized Official

Name: DR. IPERLITTA VANCE LOLIS
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 225-522-1380