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General NPI Number Information
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NPI Number | 1396042586
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Entity Type | Organization
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Legal Business Name | FORTVIEW CHIROPRACTIC CLINIC, LLC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 1714 FORTVIEW RD. SUITE 102
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City | AUSTIN
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State | TX
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Zip | 78704-7659
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Country | US
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Telephone | 512-326-5700
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Fax | 512-326-5702
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Provider Business Mailing Address
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Address Line | 1714 FORTVIEW RD. SUITE 102
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City | AUSTIN
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State | TX
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Zip | 78704-7659
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Country | US
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Telephone | 512-326-5700
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Fax | 512-326-5702
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Authorized Official
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Title or Position | OWNER/CLINIC DOCTOR
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Name | DR. ALEXIA RODRIGUEZ
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Credential | D.C.
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Telephone | 512-326-5700
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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 | TX
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