MEDICARE: PFLUGERVILLE WELLNESS CENTER 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	10084	TX

General Provider Information

NPI Number	:	1497176606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PFLUGERVILLE WELLNESS CENTER PLLC

Provider Business Mailing Address
First Line	:	2415 PECAN ST W
Second Line	:	STE 201
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-3669
Country	:	US
Telephone Number	:	512-251-9686
Fax Number	:	512-251-9488

Provider Business Practice Location Address
First Line	:	2415 PECAN ST W
Second Line	:	STE 201
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-3669
Country	:	US
Telephone Number	:	512-251-9686
Fax Number	:	512-251-9488

Authorized Official
Title or Position	:	OWNER
Name	:	TRENT PENG
Credential	:
Telephone Number	:	512-251-9686

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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