Provider Demographics
NPI:1548556780
Name:STEMX OF CENTRAL TEXAS, PLLC
Entity Type:Organization
Organization Name:STEMX OF CENTRAL TEXAS, PLLC
Other - Org Name:CHAMPION CHIROPRATIC, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-263-0270
Mailing Address - Street 1:1310 RR 620 S
Mailing Address - Street 2:STE B-4
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6300
Mailing Address - Country:US
Mailing Address - Phone:512-263-0270
Mailing Address - Fax:512-263-0276
Practice Address - Street 1:1310 RR 620 S.
Practice Address - Street 2:STE B-4
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6243
Practice Address - Country:US
Practice Address - Phone:512-263-0270
Practice Address - Fax:512-263-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty