Healthcare Provider Details

I. General information

NPI: 1184017030
Provider Name (Legal Business Name): JEPSON WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 FM 2244 RD STE A-100
AUSTIN TX
78738-5526
US

IV. Provider business mailing address

11420 FM 2244 RD STE A-100
AUSTIN TX
78738-5526
US

V. Phone/Fax

Practice location:
  • Phone: 512-263-9961
  • Fax: 512-263-9963
Mailing address:
  • Phone: 512-263-9961
  • Fax: 512-263-9963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL D JEPSON
Title or Position: OWNER-PROVIDER
Credential: DC
Phone: 512-263-9961