MEDICARE: ENLIGHTENED CHIROPRACTIC, INC

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		TX

General Provider Information

NPI Number	:	1386098721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLIGHTENED CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	1508 DESSAU RIDGE LN
Second Line	:	UNIT 702
City	:	AUSTIN
State	:	TX
Zip	:	78754-2122
Country	:	US
Telephone Number	:	512-840-0119
Fax Number	:	877-509-5308

Provider Business Practice Location Address
First Line	:	1508 DESSAU RIDGE LN
Second Line	:	UNIT 702
City	:	AUSTIN
State	:	TX
Zip	:	78754-2122
Country	:	US
Telephone Number	:	512-840-0119
Fax Number	:	877-509-5308

Authorized Official
Title or Position	:	OWNER
Name	:	KHANH NGUYEN
Credential	:	D.C.
Telephone Number	:	512-981-8765

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	05/18/2016

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