MEDICARE: SPINE INSTITUTE OF AUSTIN, PLLC

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	8468	TX

General Provider Information

NPI Number	:	1336318880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE INSTITUTE OF AUSTIN, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 341985
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78734-0034
Country	:	US
Telephone Number	:	512-444-7246
Fax Number	:	512-442-7246

Provider Business Practice Location Address
First Line	:	1901 W WILLIAM CANNON DR STE 119
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5322
Country	:	US
Telephone Number	:	512-444-7246
Fax Number	:	512-442-7246

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. THUY PETE NGUYEN
Credential	:	D.C.
Telephone Number	:	512-444-7246

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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