=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396236105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN BALANCE CHIROPRACTIC AND ACUPUNCTURE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2018
-----------------------------------------------------
Last Update Date | 05/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13740 N HWY 183 STE U1
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78750-1841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-335-5426
-----------------------------------------------------
Fax | 512-335-7426
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13740 N HWY 183 STE U1
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78750-1841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-335-5426
-----------------------------------------------------
Fax | 512-335-7426
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/MANAGER
-----------------------------------------------------
Name | DR. BUFFY DE LUNA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 512-335-5426
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 13561
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------