Healthcare Provider Details

I. General information

NPI: 1689981813
Provider Name (Legal Business Name): WORLEYHIDEAWAY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15004 AVERY RANCH BLVD A200
AUSTIN TX
78717-4600
US

IV. Provider business mailing address

15004 AVERY RANCH BLVD A200
AUSTIN TX
78717-4600
US

V. Phone/Fax

Practice location:
  • Phone: 512-255-5252
  • Fax: 512-260-5253
Mailing address:
  • Phone: 512-255-5252
  • Fax: 512-260-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10419
License Number StateTX

VIII. Authorized Official

Name: DR. RICHARD WORLEY
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 512-255-5252