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General NPI Number Information
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NPI Number | 1912366154
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Entity Type | Organization
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Legal Business Name | INNATE EXPRESSION
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 5920 W WILLIAM CANNON DR BUILDING 7, SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78749-1902
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Country | US
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Telephone | 512-956-7449
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Fax | 512-727-0394
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Provider Business Mailing Address
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Address Line | 5920 W WILLIAM CANNON DR BUILDING 7, SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78749-1902
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Country | US
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Telephone | 512-956-7449
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Fax | 512-727-0394
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Authorized Official
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Title or Position | OWNER
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Name | DR. TREVOR COLM
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Credential | D.C.
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Telephone | 214-226-2975
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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 | 12847
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License Number State | TX
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