Provider Demographics
NPI:1184851461
Name:TRENT PENG DC
Entity Type:Organization
Organization Name:TRENT PENG DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-786-2017
Mailing Address - Street 1:605 FAIRMONT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4681
Mailing Address - Country:US
Mailing Address - Phone:512-591-7446
Mailing Address - Fax:512-591-7446
Practice Address - Street 1:9070 RESEARCH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-7048
Practice Address - Country:US
Practice Address - Phone:512-786-2017
Practice Address - Fax:512-374-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty