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General NPI Number Information
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NPI Number | 1376865741
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Entity Type | Organization
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Legal Business Name | BOSTON CHIROPRACTIC
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 2630 26TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-2220
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Country | US
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Telephone | 806-765-8443
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Fax | 806-749-1181
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Provider Business Mailing Address
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Address Line | 2630 26TH ST
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City | LUBBOCK
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State | TX
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Zip | 79410-2220
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Country | US
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Telephone | 806-765-8443
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Fax | 806-749-1181
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. STEPHEN BRETT VANOSDALE
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Credential | D.C.
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Telephone | 806-765-8443
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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 | 6263
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License Number State | TX
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