MEDICARE: L & L CENTRAL HEALTHCARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7158	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80560X	OTHER	TX	BCBS
2	1265542781	OTHER	TX	NPI
3	1538376322	OTHER	TX	GROUP NPI

General Provider Information

NPI Number	:	1538376322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L & L CENTRAL HEALTHCARE, P.C.

Provider Business Mailing Address
First Line	:	2800 FORESTWOOD DR
Second Line	:	STE 102
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2792
Country	:	US
Telephone Number	:	817-649-9800
Fax Number	:	817-649-9803

Provider Business Practice Location Address
First Line	:	2800 FORESTWOOD DR
Second Line	:	STE 102
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2792
Country	:	US
Telephone Number	:	817-649-9800
Fax Number	:	817-649-9803

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. CHARLES RUSSELL LANE
Credential	:	D.C.
Telephone Number	:	817-649-9800

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	05/30/2008

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