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General NPI Number Information
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NPI Number | 1154879641
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Entity Type | Organization
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Legal Business Name | WILSON COUNTY CHIROPRACTIC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 1213 10TH STREET SUITE 3
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City | FLORESVILLE
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State | TX
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Zip | 78114
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Country | US
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Telephone | 830-253-7246
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 85
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City | FLORESVILLE
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State | TX
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Zip | 78114-0085
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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 | OWNER/DOCTOR
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Name | BRUEN C GOOLSBY
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Credential |
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Telephone | 830-253-7246
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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 |
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License Number State |
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