Healthcare Provider Details

I. General information

NPI: 1003141078
Provider Name (Legal Business Name): AMERICAN CHIROPRACTIC CLINIC - AUSTIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 SPICEWOOD SPRINGS RD STE 205
AUSTIN TX
78759-8654
US

IV. Provider business mailing address

4210 SPICEWOOD SPRINGS RD STE 205
AUSTIN TX
78759-8654
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-5567
  • Fax: 512-231-1087
Mailing address:
  • Phone: 512-346-5567
  • Fax: 512-231-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2757
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number2757
License Number StateTX

VIII. Authorized Official

Name: KRYSTLE MICHELLE RUSSO
Title or Position: MANAGER
Credential:
Phone: 512-680-6479