MEDICARE: SAMUEL R LACROIX DC

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	111NS0005X	Sports Physician Chiropractor	13032	TX

General Provider Information

NPI Number	:	1891241337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL R LACROIX DC

Provider Business Mailing Address
First Line	:	1120 S CAPITAL OF TEXAS HWY
Second Line	:	BLDG 1 STE 250
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6464
Country	:	US
Telephone Number	:	512-258-4425
Fax Number	:	512-258-4553

Provider Business Practice Location Address
First Line	:	1120 S CAPITAL OF TEXAS HWY
Second Line	:	BLDG 1 STE 250
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6464
Country	:	US
Telephone Number	:	512-258-4425
Fax Number	:	512-258-4553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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Directions to “ SAMUEL R LACROIX DC” Practice Location

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