Healthcare Provider Details

I. General information

NPI: 1992920342
Provider Name (Legal Business Name): L & L CENTRAL HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CUSTER RD
RICHARDSON TX
75080-5141
US

IV. Provider business mailing address

905 CUSTER RD
RICHARDSON TX
75080-5141
US

V. Phone/Fax

Practice location:
  • Phone: 972-680-1100
  • Fax: 972-680-1108
Mailing address:
  • Phone: 972-680-1100
  • Fax: 972-680-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC7158
License Number StateTX

VIII. Authorized Official

Name: DR. CHARLES RUSSEL LANE
Title or Position: OWNER
Credential: D.C.
Phone: 972-680-1100