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General NPI Number Information
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NPI Number | 1003330911
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Entity Type | Organization
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Legal Business Name | RISE UP CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2951 FM 1460 UNIT 1402
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City | GEORGETOWN
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State | TX
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Zip | 78626-7429
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Country | US
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Telephone | 512-729-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 2951 FM 1460 UNIT 1402
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City | GEORGETOWN
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State | TX
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Zip | 78626-7429
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Country | US
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Telephone | 512-729-3315
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | SHANNA MARIE JACKSON
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Credential | DC
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Telephone | 512-729-3315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 13556
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License Number State | TX
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