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General NPI Number Information
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NPI Number | 1598904559
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Entity Type | Organization
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Legal Business Name | LAKE TRAVIS CHIROPRACTIC
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Dates
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Enumeration Date | 02/16/2009
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 1700 RANCH ROAD 620 N STE 108
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City | LAKEWAY
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State | TX
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Zip | 78734-2788
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Country | US
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Telephone | 737-359-0888
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Fax | 512-727-5658
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Provider Business Mailing Address
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Address Line | 1700 RANCH ROAD 620 N STE 108
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City | LAKEWAY
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State | TX
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Zip | 78734-2788
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Country | US
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Telephone | 737-359-0888
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Fax | 512-727-5658
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Authorized Official
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Title or Position | DOCTOR/ OWNER
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Name | DR. LAURENCE RYAN SMITH
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Credential | D.C.
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Telephone | 808-639-1272
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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 | 10965
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License Number State | TX
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