Provider Demographics
NPI:1205364221
Name:BOLD CHIROPRACTIC AND REHABILITATION PLLC
Entity Type:Organization
Organization Name:BOLD CHIROPRACTIC AND REHABILITATION PLLC
Other - Org Name:FITLAB REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOREA
Authorized Official - Middle Name:WILDER
Authorized Official - Last Name:NEIGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:512-567-6343
Mailing Address - Street 1:1705 S CAPITAL OF TEXAS HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6551
Mailing Address - Country:US
Mailing Address - Phone:512-567-6343
Mailing Address - Fax:833-807-0121
Practice Address - Street 1:1705 S CAPITAL OF TEXAS HWY STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6551
Practice Address - Country:US
Practice Address - Phone:512-567-6343
Practice Address - Fax:833-807-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty