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General NPI Number Information
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NPI Number | 1336689595
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Entity Type | Organization
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Legal Business Name | DRCATHYPHAMDCPROFESSIONALCORPORATION
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 2028 E BEN WHITE BLVD SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78741-6966
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Country | US
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Telephone | 512-902-4860
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Fax |
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Provider Business Mailing Address
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Address Line | 11904 AITNE LN
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City | AUSTIN
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State | TX
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Zip | 78725-1768
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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 | PROVIDER
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Name | CATHY PHAM
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Credential |
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Telephone | 512-902-4860
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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 | 11829
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License Number State | TX
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