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General NPI Number Information
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NPI Number | 1669650842
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Entity Type | Organization
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Legal Business Name | TRIUNE A CREATING WELLNESS CENTER
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Dates
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Enumeration Date | 02/10/2008
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Last Update Date | 02/10/2008
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Provider Practice Location Address
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Address Line | 1102 S AUSTIN AVE STE 103
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City | GEORGETOWN
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State | TX
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Zip | 78626-6756
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Country | US
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Telephone | 512-868-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 S AUSTIN AVE STE 103
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City | GEORGETOWN
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State | TX
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Zip | 78626-6756
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Country | US
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Telephone | 512-868-8900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES MICHAEL CRUMP JR.
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Credential | DC
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Telephone | 512-868-8900
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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 | 9061
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License Number State | TX
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