Healthcare Provider Details

I. General information

NPI: 1750547832
Provider Name (Legal Business Name): LIVE OAK CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N US HIGHWAY 183 SUITE 155
LEANDER TX
78641-8990
US

IV. Provider business mailing address

651 N US HIGHWAY 183 SUITE 155
LEANDER TX
78641-8990
US

V. Phone/Fax

Practice location:
  • Phone: 512-772-3088
  • Fax:
Mailing address:
  • Phone: 512-772-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10854
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number10854
License Number StateTX

VIII. Authorized Official

Name: DR. DOUGLAS EARL FALKE
Title or Position: OWNER
Credential: D.C.
Phone: 512-772-3088