=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538376322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L & L CENTRAL HEALTHCARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 05/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 FORESTWOOD DR STE 102
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76006-2792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-649-9800
-----------------------------------------------------
Fax | 817-649-9803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 FORESTWOOD DR STE 102
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76006-2792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-649-9800
-----------------------------------------------------
Fax | 817-649-9803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. CHARLES RUSSELL LANE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 817-649-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 7158
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------