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General NPI Number Information
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NPI Number | 1417437989
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Entity Type | Organization
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Legal Business Name | LONE STAR HEALTH, LLC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 10 E RUTH AVE
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City | PHOENIX
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State | AZ
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Zip | 85020-3131
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Country | US
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Telephone | 480-888-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 E CHOLLA ST
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City | PHOENIX
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State | AZ
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Zip | 85020-1413
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Country | US
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Telephone | 480-888-5555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICENTE CHAVIRA
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Credential | DC
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Telephone | 480-888-5555
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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 | 8328
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License Number State | AZ
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