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General NPI Number Information
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NPI Number | 1518457621
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Entity Type | Organization
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Legal Business Name | AUSTIN SPORTS CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 13062 US 290 W SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78737
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Country | US
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Telephone | 512-362-8865
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Fax | 888-660-3135
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Provider Business Mailing Address
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Address Line | 13062 US-290
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City | AUSTIN
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State | TX
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Zip | 78737-8811
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Country | US
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Telephone | 512-362-8865
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Fax | 888-660-3135
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Authorized Official
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Title or Position | OWNER
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Name | JON EBERLE
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Credential | DC
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Telephone | 512-362-8865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 13295
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 13264
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License Number State | TX
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