MEDICARE: NORTH LAMAR CHIROPRACTIC CLINIC

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	4013	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	601556	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1932100336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH LAMAR CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	10102 N LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-3602
Country	:	US
Telephone Number	:	812-835-1955
Fax Number	:	512-835-4424

Provider Business Practice Location Address
First Line	:	10102 N LAMAR BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-3602
Country	:	US
Telephone Number	:	812-835-1955
Fax Number	:	512-835-4424

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH H LONES III
Credential	:	DC
Telephone Number	:	512-835-1955

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/22/2020

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