MEDICARE: DR. TRIA NIETSCHE MCKIRDY 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
1	111N00000X	Chiropractor	10090	TX

General Provider Information

NPI Number	:	1942239470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRIA NIETSCHE MCKIRDY D.C.

Provider Business Mailing Address
First Line	:	8600 GRANADA HILLS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-1443
Country	:	US
Telephone Number	:	512-299-8331
Fax Number	:	512-551-9445

Provider Business Practice Location Address
First Line	:	802 W SAINT ELMO RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1153
Country	:	US
Telephone Number	:	512-299-8331
Fax Number	:	512-551-9445

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	06/12/2020

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