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General NPI Number Information
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NPI Number | 1588061758
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Entity Type | Organization
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Legal Business Name | THRIVE CHIROPRACTIC CENTER LL
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 15501 RANCH ROAD 620 N SUITE 1200
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City | AUSTIN
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State | TX
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Zip | 78717-5207
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Country | US
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Telephone | 512-808-8215
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Fax |
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Provider Business Mailing Address
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Address Line | 15501 RANCH ROAD 620 N SUITE 1200
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City | AUSTIN
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State | TX
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Zip | 78717-5207
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Country | US
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Telephone | 512-808-8215
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CORY R ELLERBROEK
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Credential | D.C.
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Telephone | 319-750-1624
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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 | 12703
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License Number State | TX
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