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General NPI Number Information
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NPI Number | 1235311721
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Entity Type | Organization
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Legal Business Name | FIRE OF LIFE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 1200 LAKEWAY DR 17B
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City | LAKEWAY
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State | TX
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Zip | 78734-4400
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Country | US
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Telephone | 512-608-9121
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Fax | 512-608-9121
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Provider Business Mailing Address
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Address Line | 1200 LAKEWAY DR 17B
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City | LAKEWAY
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State | TX
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Zip | 78734-4400
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Country | US
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Telephone | 512-608-9121
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Fax | 512-608-9121
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KURT VANESSA EDEKER
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Credential |
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Telephone | 512-608-9121
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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 | 9962
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License Number State | TX
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