Provider Demographics
NPI:1003141078
Name:AMERICAN CHIROPRACTIC CLINIC - AUSTIN LLC
Entity Type:Organization
Organization Name:AMERICAN CHIROPRACTIC CLINIC - AUSTIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-680-6479
Mailing Address - Street 1:4210 SPICEWOOD SPRINGS RD STE 205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8654
Mailing Address - Country:US
Mailing Address - Phone:512-346-5567
Mailing Address - Fax:512-231-1087
Practice Address - Street 1:4210 SPICEWOOD SPRINGS RD STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8654
Practice Address - Country:US
Practice Address - Phone:512-346-5567
Practice Address - Fax:512-231-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2757111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty