MEDICARE: MARY CELESTE TRAVERSE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7346	TX

General Provider Information

NPI Number	:	1275692618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CELESTE TRAVERSE DC

Provider Business Mailing Address
First Line	:	2115 COUNTY ROAD 332 # 103
Second Line	:
City	:	BERTRAM
State	:	TX
Zip	:	78605-4383
Country	:	US
Telephone Number	:	512-345-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 COUNTY ROAD 332
Second Line	:
City	:	BERTRAM
State	:	TX
Zip	:	78605-4383
Country	:	US
Telephone Number	:	512-345-4300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	11/30/2023

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Directions to “ MARY CELESTE TRAVERSE DC” Practice Location

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