Provider Demographics
NPI:1639453509
Name:CYCO LLC
Entity Type:Organization
Organization Name:CYCO LLC
Other - Org Name:DBA ROCK CHIROPRACTIC LEANDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-259-9922
Mailing Address - Street 1:808 CRYSTAL FALLS PWKY
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-259-9922
Mailing Address - Fax:512-259-9923
Practice Address - Street 1:808 CRYSTAL FALLS PKWY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3665
Practice Address - Country:US
Practice Address - Phone:512-259-9922
Practice Address - Fax:512-259-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX9541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613056Medicare PIN