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General NPI Number Information
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NPI Number | 1053630327
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Entity Type | Organization
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Legal Business Name | SOUTHLAKE HEALTH P.C.
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 100 W SOUTHLAKE BLVD SUITE # 410
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6100
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Country | US
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Telephone | 817-310-6604
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Fax | 817-310-6478
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Provider Business Mailing Address
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Address Line | 100 W SOUTHLAKE BLVD SUITE # 410
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6100
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Country | US
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Telephone | 817-310-6604
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Fax | 817-310-6478
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. ROBERT MEYER
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Credential | D.C.
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Telephone | 817-310-6604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 10567
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License Number State | TX
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