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General NPI Number Information
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NPI Number | 1548512163
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Entity Type | Organization
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Legal Business Name | ONSITE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 1929 PAYTON GIN RD STE E
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City | AUSTIN
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State | TX
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Zip | 78757-8501
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Country | US
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Telephone | 512-762-5880
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Fax | 512-582-8447
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Provider Business Mailing Address
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Address Line | PO BOX 4098
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City | AUSTIN
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State | TX
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Zip | 78765-4098
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Country | US
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Telephone | 512-762-5880
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Fax | 512-582-8447
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. DIANA DE LA ROSA
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Credential | DC
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Telephone | 512-762-5880
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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 | 6981
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License Number State | TX
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