Healthcare Provider Details

I. General information

NPI: 1619484888
Provider Name (Legal Business Name): LSS MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 S INTERSTATE 35
NEW BRAUNFELS TX
78130-4817
US

IV. Provider business mailing address

PO BOX 47626
SAN ANTONIO TX
78265-8626
US

V. Phone/Fax

Practice location:
  • Phone: 830-358-1446
  • Fax: 830-358-1646
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: COREY SORUM
Title or Position: CEO
Credential: DC
Phone: 830-358-1446