MEDICARE: JAMES RUSSELL ALLGOOD

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	12716	TX

General Provider Information

NPI Number	:	1235533647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RUSSELL ALLGOOD

Provider Business Mailing Address
First Line	:	5145 FM 620 N STE F-130
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1815
Country	:	US
Telephone Number	:	512-554-9937
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 FM 620 N STE F-130
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1815
Country	:	US
Telephone Number	:	512-554-9937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	08/01/2017

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Directions to “ JAMES RUSSELL ALLGOOD ” Practice Location

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