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General NPI Number Information
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NPI Number | 1851707699
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Entity Type | Organization
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Legal Business Name | FEDESNA CHIROPRACTIC
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 8740 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78753-5440
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Country | US
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Telephone | 512-835-1182
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Fax | 512-835-1888
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Provider Business Mailing Address
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Address Line | 8740 N LAMAR BLVD
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City | AUSTIN
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State | TX
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Zip | 78753-5440
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Country | US
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Telephone | 512-835-1182
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Fax | 512-835-1888
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID R. FEDESNA
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Credential | D.C.
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Telephone | 512-835-1182
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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 | 4227
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License Number State | TX
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