Provider Demographics
NPI:1437692332
Name:WHITESTONE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WHITESTONE CHIROPRACTIC LLC
Other - Org Name:100 PERCENT CHIROPRACTIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-986-7329
Mailing Address - Street 1:1335 E WHITESTONE BLVD
Mailing Address - Street 2:STE. O-300
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7598
Mailing Address - Country:US
Mailing Address - Phone:512-986-7329
Mailing Address - Fax:512-986-9070
Practice Address - Street 1:1335 E WHITESTONE BLVD
Practice Address - Street 2:STE. O-300
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7598
Practice Address - Country:US
Practice Address - Phone:512-986-7329
Practice Address - Fax:512-986-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty