Healthcare Provider Details

I. General information

NPI: 1780305425
Provider Name (Legal Business Name): SAMANTHA MARIE OBRIEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DISCOVERY BLVD STE 404
CEDAR PARK TX
78613-2417
US

IV. Provider business mailing address

5629 N LAMAR BLVD
AUSTIN TX
78751-1119
US

V. Phone/Fax

Practice location:
  • Phone: 512-426-8646
  • Fax:
Mailing address:
  • Phone: 630-816-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: