MEDICARE: BASTROP COUNTY CHIROPRACTIC CLINC

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

General Provider Information

NPI Number	:	1992835292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASTROP COUNTY CHIROPRACTIC CLINC

Provider Business Mailing Address
First Line	:	4849 FM 535 UNIT B
Second Line	:
City	:	CEDAR CREEK
State	:	TX
Zip	:	78612-3651
Country	:	US
Telephone Number	:	512-303-5296
Fax Number	:	512-303-5535

Provider Business Practice Location Address
First Line	:	4849 FM 535 UNIT B
Second Line	:
City	:	CEDAR CREEK
State	:	TX
Zip	:	78612-3651
Country	:	US
Telephone Number	:	512-303-5296
Fax Number	:	512-303-5535

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MELBA ANN CONLEY
Credential	:	RN
Telephone Number	:	512-303-5296

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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