| NPI | 1003141078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTLE MICHELLE RUSSO Manager 512-680-6479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 2757) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: TX 2757) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2023-07-12 |