1669761052 NPI number — LLT ASSOCIATES

Table of content: (NPI 1669761052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669761052 NPI number — LLT ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LLT ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VISTA RIDGE CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669761052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
297 W ROUND GROVE RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75067-8128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-315-0518
Provider Business Mailing Address Fax Number:
972-315-2909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
297 W ROUND GROVE RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75067-8128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-315-0518
Provider Business Practice Location Address Fax Number:
972-315-2909
Provider Enumeration Date:
04/06/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TERRY
Authorized Official First Name:
LANCE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-315-0518

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6789 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 618923 . This is a "UNITED HC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: U56557 . This is a "UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5268017 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 605857 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".