MEDICARE: AMERICAN CHIROPRACTIC CLINIC - AUSTIN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	2757	TX
2	111N00000X	Chiropractor	2757	TX

General Provider Information

NPI Number	:	1003141078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN CHIROPRACTIC CLINIC - AUSTIN LLC

Provider Business Mailing Address
First Line	:	4210 SPICEWOOD SPRINGS RD STE 205
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8654
Country	:	US
Telephone Number	:	512-346-5567
Fax Number	:	512-231-1087

Provider Business Practice Location Address
First Line	:	4210 SPICEWOOD SPRINGS RD STE 205
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8654
Country	:	US
Telephone Number	:	512-346-5567
Fax Number	:	512-231-1087

Authorized Official
Title or Position	:	MANAGER
Name	:	KRYSTLE MICHELLE RUSSO
Credential	:
Telephone Number	:	512-680-6479

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	07/12/2023

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