Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7996 | TX |
NPI | 1003951021 |
---|---|
Provider Name | Dr. Alwyn Anthony Lorenzo |
First Address | Haltom City, TX 76111-6703 |
Second Address | Haltom City, TX 76111-6703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 29/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V06870 | (02) | TX |