=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497955181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VICTORIA CHIROPRACTIC CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2007
-----------------------------------------------------
Last Update Date | 02/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2004 PATTERSON DR
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-5645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-578-9966
-----------------------------------------------------
Fax | 361-578-9997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2004 PATTERSON DR
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-5645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-578-9966
-----------------------------------------------------
Fax | 361-578-9997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LONNIE RAY FRANKA JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 361-578-9966
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 9159DC
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------