Healthcare Provider Details

I. General information

NPI: 1932743580
Provider Name (Legal Business Name): FAULKNER SPORTS MEDICINE & CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S BAGDAD RD STE 200
LEANDER TX
78641-2432
US

IV. Provider business mailing address

2303 S BAGDAD RD STE 200
LEANDER TX
78641-2432
US

V. Phone/Fax

Practice location:
  • Phone: 512-528-6009
  • Fax: 512-528-3690
Mailing address:
  • Phone: 512-528-6009
  • Fax: 512-528-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGHAN FAULKNER
Title or Position: OWNER, CHIROPRACTOR
Credential: DC, CCSP
Phone: 512-528-6009