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General NPI Number Information
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NPI Number | 1073520227
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Entity Type | Individual
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Provider Name | ROY ALLEN LOGAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11507 N. LAMAR BLVD SUITE A
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City | AUSTIN
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State | TX
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Zip | 78753-2691
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Country | US
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Telephone | 512-215-3256
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Fax |
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Provider Business Mailing Address
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Address Line | 151 FLAT BOAT CIR
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City | DRIPPING SPRINGS
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State | TX
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Zip | 78620-4481
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9666
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License Number State | TX
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