Healthcare Provider Details

I. General information

NPI: 1205364221
Provider Name (Legal Business Name): BOLD CHIROPRACTIC AND REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2017
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 S CAPITAL OF TEXAS HWY STE 300
AUSTIN TX
78746-6551
US

IV. Provider business mailing address

1705 S CAPITAL OF TEXAS HWY STE 300
AUSTIN TX
78746-6551
US

V. Phone/Fax

Practice location:
  • Phone: 512-567-6343
  • Fax: 833-807-0121
Mailing address:
  • Phone: 512-567-6343
  • Fax: 833-807-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DOREA WILDER NEIGERT
Title or Position: OWNER
Credential: DC, CCSP
Phone: 512-567-6343