Healthcare Provider Details

I. General information

NPI: 1699366260
Provider Name (Legal Business Name): CAPITAL INJURY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6448 E HWY 290 STE D105
AUSTIN TX
78723-1040
US

IV. Provider business mailing address

6448 E HWY 290 STE D105
AUSTIN TX
78723-1040
US

V. Phone/Fax

Practice location:
  • Phone: 512-549-6100
  • Fax: 512-549-6101
Mailing address:
  • Phone: 512-549-6100
  • Fax: 512-549-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL MARTINEZ
Title or Position: OWNER
Credential: DC
Phone: 512-549-6100