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General NPI Number Information
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NPI Number | 1689964223
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Entity Type | Individual
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Provider Name | JOHNATHAN NELSON HOUSE DC, LAT
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Gender | Male
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Dates
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Enumeration Date | 04/17/2011
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 6203 N FM 2528
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City | LUBBOCK
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State | TX
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Zip | 79415-4961
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Country | US
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Telephone | 806-747-1936
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Fax |
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Provider Business Mailing Address
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Address Line | 6203 N FM 2528
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City | LUBBOCK
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State | TX
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Zip | 79415-4961
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11612
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | AT4786
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License Number State | TX
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