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General NPI Number Information
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NPI Number | 1093028516
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Entity Type | Organization
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Legal Business Name | LOGAN CHIROPRACTIC AND WELLNESS CENTER
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 9800 N LAMAR BLVD STE 140
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City | AUSTIN
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State | TX
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Zip | 78753-4160
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Country | US
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Telephone | 512-873-9355
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Fax | 512-873-8858
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Provider Business Mailing Address
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Address Line | 9800 NORTH LAMAR BLVD STE 140
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City | AUSTIN
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State | TX
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Zip | 78753-4144
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Country | US
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Telephone | 512-873-9355
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Fax | 512-873-8858
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Authorized Official
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Title or Position | OWNER/PROVDER
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Name | DR. DEBORAH L LOGAN
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Credential | DC
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Telephone | 512-873-9355
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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 | 6229
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License Number State | TX
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