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General NPI Number Information
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NPI Number | 1689107047
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Entity Type | Organization
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Legal Business Name | LAKE JACKSON CHIROPRACTIC AND REHAB PC
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 209 PARKING WAY ST SUITE B
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5226
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Country | US
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Telephone | 979-292-8032
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Fax | 844-736-0238
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Provider Business Mailing Address
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Address Line | 209 PARKING WAY ST SUITE B
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5226
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Country | US
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Telephone | 979-292-8032
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Fax | 844-736-0238
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT A. WOODARD II
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Credential | D.C.
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Telephone | 979-292-8032
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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 | 12614
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License Number State | TX
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