Provider Demographics
NPI:1033547179
Name:SPINE IN LINE CHIROPRACTIC AND REHABILITATION, PC
Entity Type:Organization
Organization Name:SPINE IN LINE CHIROPRACTIC AND REHABILITATION, PC
Other - Org Name:ROUND ROCK CHIROPRACTIC AND REHABILITATION, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GESKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-310-7177
Mailing Address - Street 1:3309 FOREST CREEK DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6168
Mailing Address - Country:US
Mailing Address - Phone:512-310-7177
Mailing Address - Fax:
Practice Address - Street 1:3309 FOREST CREEK DR UNIT 101
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6168
Practice Address - Country:US
Practice Address - Phone:512-310-7177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty