Provider Demographics
NPI:1558643411
Name:HOUSTON, LORIE (DC)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:MELISSA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7252 MARIMEL LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4249
Mailing Address - Country:US
Mailing Address - Phone:804-690-4267
Mailing Address - Fax:
Practice Address - Street 1:7468 LEE DAVIS RD STE 1
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3678
Practice Address - Country:US
Practice Address - Phone:804-840-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor