Provider Demographics
NPI:1164721171
Name:DRAKE CHIROPRACTIC OF AUSTIN, INC
Entity Type:Organization
Organization Name:DRAKE CHIROPRACTIC OF AUSTIN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-973-3900
Mailing Address - Street 1:9037 RESEARCH BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7006
Mailing Address - Country:US
Mailing Address - Phone:512-973-3900
Mailing Address - Fax:512-973-3905
Practice Address - Street 1:9037 RESEARCH BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-7006
Practice Address - Country:US
Practice Address - Phone:512-973-3900
Practice Address - Fax:512-973-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609818Medicare UPIN