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General NPI Number Information
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NPI Number | 1952576019
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Entity Type | Organization
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Legal Business Name | BCDC PLLC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 4634 W GATE BLVD
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City | AUSTIN
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State | TX
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Zip | 78745-1461
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Country | US
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Telephone | 512-288-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 4634 W GATE BLVD
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City | AUSTIN
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State | TX
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Zip | 78745-1461
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Country | US
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Telephone | 512-288-7000
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. BRIAN ALAN CLARK
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Credential | DC
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Telephone | 512-288-7000
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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 | 10645
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License Number State | TX
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