Provider Demographics
NPI:1689981813
Name:WORLEYHIDEAWAY PA
Entity Type:Organization
Organization Name:WORLEYHIDEAWAY PA
Other - Org Name:SALUS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-255-5252
Mailing Address - Street 1:15004 AVERY RANCH BLVD
Mailing Address - Street 2:A200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4600
Mailing Address - Country:US
Mailing Address - Phone:512-255-5252
Mailing Address - Fax:512-260-5253
Practice Address - Street 1:15004 AVERY RANCH BLVD
Practice Address - Street 2:A200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4600
Practice Address - Country:US
Practice Address - Phone:512-255-5252
Practice Address - Fax:512-260-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty