Healthcare Provider Details

I. General information

NPI: 1598987653
Provider Name (Legal Business Name): SJC AUSTIN CHIROPRACTIC AND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 CONGRESS AVE STE 980
AUSTIN TX
78701-2490
US

IV. Provider business mailing address

13945 N HIGHWAY 183 STE C3
AUSTIN TX
78717-5911
US

V. Phone/Fax

Practice location:
  • Phone: 512-499-0366
  • Fax:
Mailing address:
  • Phone: 512-336-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7159
License Number StateTX

VIII. Authorized Official

Name: JIM LAY
Title or Position: OWNER
Credential: DC
Phone: 512-499-0366