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General NPI Number Information
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NPI Number | 1578747101
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Entity Type | Organization
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Legal Business Name | ISLAND CHIROPRACTIC AND ACUPUNCTURE CLINIC LLC
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 3311 PADRE BLVD SUITE B
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City | SOUTH PADRE ISLAND
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State | TX
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Zip | 78597-7048
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Country | US
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Telephone | 956-761-6006
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Fax | 956-761-6002
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Provider Business Mailing Address
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Address Line | 3311 PADRE BLVD SUITE B
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City | SOUTH PADRE ISLAND
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State | TX
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Zip | 78597-7048
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Country | US
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Telephone | 956-761-6006
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Fax | 956-761-6002
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Authorized Official
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Title or Position | PRESIDENT/CHIROPRACTOR
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Name | DR. JOEY LEE LASKE
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Credential | D.C.
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Telephone | 956-761-6006
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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 | 8835
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License Number State | TX
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