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General NPI Number Information
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NPI Number | 1760740724
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Entity Type | Organization
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Legal Business Name | CENTRAL CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 2800 BARTONS BLUFF LN STE 403
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City | AUSTIN
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State | TX
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Zip | 78746-7948
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Country | US
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Telephone | 972-746-0050
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Fax | 512-590-8734
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Provider Business Mailing Address
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Address Line | 2800 BARTONS BLUFF LN STE 403
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City | AUSTIN
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State | TX
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Zip | 78746-7948
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Country | US
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Telephone | 972-746-0050
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Fax | 512-590-8734
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTIE GADDIS
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Credential | D.C.
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Telephone | 972-746-0050
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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 | 6291
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License Number State | TX
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