Provider Demographics
NPI:1033341946
Name:KIMBERLY MAULDIN HEINRICH, D.C.
Entity Type:Organization
Organization Name:KIMBERLY MAULDIN HEINRICH, D.C.
Other - Org Name:MAULDIN HEINRICH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MAULDIN
Authorized Official - Last Name:HEINRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-795-0707
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:#O-1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8661
Mailing Address - Country:US
Mailing Address - Phone:512-795-0707
Mailing Address - Fax:512-502-5496
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:#O-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-795-0707
Practice Address - Fax:512-502-5496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMBERLY MAULDIN HEINRICH, D.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1219339OtherHUMANA #1219339
TX8M2021OtherBCBS 8M2021 GROUP #0071LC
TX1219339OtherHUMANA #1219339
TX603163Medicare PIN