Healthcare Provider Details

I. General information

NPI: 1750176376
Provider Name (Legal Business Name): SPINE AND INJURY CENTER OF AUSTIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 WEST HWY 290 SERVICE ROAD
AUSTIN TX
78735
US

IV. Provider business mailing address

1603 MEDICAL PKWY STE 310
CEDAR PARK TX
78613-7904
US

V. Phone/Fax

Practice location:
  • Phone: 512-918-2225
  • Fax:
Mailing address:
  • Phone: 512-918-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SHANE DAVIDSON
Title or Position: OWNER
Credential: DC
Phone: 512-918-2225