Healthcare Provider Details

I. General information

NPI: 1114178555
Provider Name (Legal Business Name): ACE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13740 N HIGHWAY 183 STE G4
AUSTIN TX
78750
US

IV. Provider business mailing address

13740 N HIGHWAY 183 STE G3
AUSTIN TX
78750-1821
US

V. Phone/Fax

Practice location:
  • Phone: 512-339-1888
  • Fax: 512-339-1889
Mailing address:
  • Phone: 512-339-1888
  • Fax: 512-339-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10937
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01614
License Number StateTX

VIII. Authorized Official

Name: BYOUNG CHAN LEE
Title or Position: OWNER
Credential: D.C.. LAC
Phone: 512-339-1888