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General NPI Number Information
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NPI Number | 1720486723
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Entity Type | Organization
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Legal Business Name | DDB WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 827 W 12TH ST
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City | AUSTIN
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State | TX
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Zip | 78701-1701
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Country | US
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Telephone | 512-659-6020
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Fax |
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Provider Business Mailing Address
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Address Line | 6109 CADDIE ST # A
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City | AUSTIN
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State | TX
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Zip | 78741-5101
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Country | US
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Telephone | 512-659-6020
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. DEVOREE DARRIN BANG
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Credential | D.C.
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Telephone | 512-659-6020
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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 | 11742
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License Number State | TX
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