Provider Demographics
NPI:1518109099
Name:TX SPINE & SPORTS THERAPY CTR PLLC
Entity Type:Organization
Organization Name:TX SPINE & SPORTS THERAPY CTR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:604-599-1895
Mailing Address - Street 1:1500 WEST 38TH STREET
Mailing Address - Street 2:SUITE 38
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6321
Mailing Address - Country:US
Mailing Address - Phone:512-219-8999
Mailing Address - Fax:512-219-7890
Practice Address - Street 1:1500 WEST 38TH STREET
Practice Address - Street 2:SUITE 38
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6321
Practice Address - Country:US
Practice Address - Phone:512-219-8999
Practice Address - Fax:512-219-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU74885Medicare UPIN