Provider Demographics
NPI:1669761052
Name:LLT ASSOCIATES
Entity type:Organization
Organization Name:LLT ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-315-0518
Mailing Address - Street 1:297 W ROUND GROVE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8128
Mailing Address - Country:US
Mailing Address - Phone:972-315-0518
Mailing Address - Fax:972-315-2909
Practice Address - Street 1:297 W ROUND GROVE RD STE 120
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8128
Practice Address - Country:US
Practice Address - Phone:972-315-0518
Practice Address - Fax:972-315-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX618923OtherUNITED HC
TXU56557OtherUPIN
TX5268017OtherAETNA
TX605857OtherBCBS
TX609099Medicare PIN