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General NPI Number Information
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NPI Number | 1760893861
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Entity Type | Organization
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Legal Business Name | AUSTIN AVENUE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 2030 S AUSTIN AVE
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City | GEORGETOWN
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State | TX
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Zip | 78626-7810
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Country | US
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Telephone | 512-869-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 S AUSTIN AVE
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City | GEORGETOWN
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State | TX
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Zip | 78626-7810
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Country | US
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Telephone |
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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. BRANDON HARSHE
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Credential | D.C.
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Telephone | 806-983-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 11348
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License Number State | TX
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