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General NPI Number Information
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NPI Number | 1073624110
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Entity Type | Organization
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Legal Business Name | LAKEWAY SPINE CENTER, INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11614 ARGONNE FOREST TRL # B
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City | AUSTIN
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State | TX
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Zip | 78759-2226
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Country | US
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Telephone | 512-294-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 RANCH ROAD 620 S SUITE 201-B
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City | LAKEWAY
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State | TX
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Zip | 78734-6340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA MICHELLE LUISE-WILLIAMS
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Credential | D.C.
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Telephone | 512-294-2210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 10245
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License Number State | TX
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