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NPI Code Detail

MEDICARE: DR. JEREL KENNETH WOTTRICH SR. D.C.

MEDICARE: DR. JEREL KENNETH WOTTRICH SR. D.C.
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
1111N00000XChiropractorDC2911TX

General Provider Information

NPI Number : 1679667349
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREL KENNETH WOTTRICH SR. D.C.
Provider Business Mailing Address
First Line : 2121 E OLTORF SUITE 2
Second Line :
City : AUSTIN
State : TX
Zip : 78741
Country : US
Telephone Number : 512-448-1012
Fax Number : 512-448-2706
Provider Business Practice Location Address
First Line : 2121 E OLTORF SUITE 2
Second Line :
City : AUSTIN
State : TX
Zip : 78741
Country : US
Telephone Number : 512-448-1012
Fax Number : 512-448-2706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/08/2007

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