MEDICARE: SPINE IN LINE CHIROPRACTIC AND REHABILITATION, PC

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	111N00000X	Chiropractor	12361	TX

General Provider Information

NPI Number	:	1033547179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE IN LINE CHIROPRACTIC AND REHABILITATION, PC

Provider Business Mailing Address
First Line	:	3309 FOREST CREEK DR UNIT 101
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6168
Country	:	US
Telephone Number	:	512-310-7177
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 FOREST CREEK DR UNIT 101
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6168
Country	:	US
Telephone Number	:	512-310-7177
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEAN ANDREW GESKE
Credential	:
Telephone Number	:	512-310-7177

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/26/2020

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