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General NPI Number Information
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NPI Number | 1992835292
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Entity Type | Organization
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Legal Business Name | BASTROP COUNTY CHIROPRACTIC CLINC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4849 FM 535 UNIT B
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City | CEDAR CREEK
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State | TX
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Zip | 78612-3651
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Country | US
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Telephone | 512-303-5296
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Fax | 512-303-5535
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Provider Business Mailing Address
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Address Line | 4849 FM 535 UNIT B
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City | CEDAR CREEK
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State | TX
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Zip | 78612-3651
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Country | US
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Telephone | 512-303-5296
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Fax | 512-303-5535
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELBA ANN CONLEY
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Credential | RN
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Telephone | 512-303-5296
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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 |
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License Number State |
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