Healthcare Provider Details

I. General information

NPI: 1245692615
Provider Name (Legal Business Name): ENDURANCE CHIROPRACTIC AND SPORTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 50TH ST
LUBBOCK TX
79413-3808
US

IV. Provider business mailing address

3838 50TH ST
LUBBOCK TX
79413-3808
US

V. Phone/Fax

Practice location:
  • Phone: 806-785-7514
  • Fax: 806-785-7582
Mailing address:
  • Phone: 806-785-7514
  • Fax: 806-785-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11498
License Number StateTX

VIII. Authorized Official

Name: DR. RYAN ALAN DOSS
Title or Position: OWNER
Credential: DC
Phone: 806-785-7514