MEDICARE: L G BREEDLOVE, PLLC

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	4064	TX

General Provider Information

NPI Number	:	1891806618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L G BREEDLOVE, PLLC

Provider Business Mailing Address
First Line	:	3839 BEE CAVE RD STE 202
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5318
Country	:	US
Telephone Number	:	512-327-2921
Fax Number	:	512-327-4944

Provider Business Practice Location Address
First Line	:	3839 BEE CAVE RD STE 202
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5318
Country	:	US
Telephone Number	:	512-327-2921
Fax Number	:	512-327-4944

Authorized Official
Title or Position	:	PRINCIPAL OFFICER
Name	:	DR. LARRY G BREEDLOVE
Credential	:	DC
Telephone Number	:	512-327-2921

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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