Provider Demographics
NPI:1518457621
Name:AUSTIN SPORTS CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:AUSTIN SPORTS CHIROPRACTIC PLLC
Other - Org Name:PRECISION CHIROPRACTIC ATX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-362-8865
Mailing Address - Street 1:13062 US-290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-8811
Mailing Address - Country:US
Mailing Address - Phone:512-362-8865
Mailing Address - Fax:888-660-3135
Practice Address - Street 1:13062 US 290 W
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737
Practice Address - Country:US
Practice Address - Phone:512-362-8865
Practice Address - Fax:888-660-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13295111NP0017X
TX13264111NX0800X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty