1851647408 NPI number — AUSTIN CHIROPRACTIC AND WELLNESS LTD LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851647408 NPI number — AUSTIN CHIROPRACTIC AND WELLNESS LTD LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN CHIROPRACTIC AND WELLNESS LTD LLP
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:
Provider Other Organization Name Type Code:
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:
1851647408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13740 N HIGHWAY 183
Provider Second Line Business Mailing Address:
STE L4
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78750-1884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-257-3627
Provider Business Mailing Address Fax Number:
512-257-9870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13740 N HIGHWAY 183
Provider Second Line Business Practice Location Address:
STE L4
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78750-1884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-257-3627
Provider Business Practice Location Address Fax Number:
512-257-9870
Provider Enumeration Date:
08/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BOTTS
Authorized Official First Name:
TREVOR
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
512-257-3627

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  11922 , 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)





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