Provider Demographics
NPI:1699022749
Name:BARTON CREEK CHIROPRACTIC,LLC
Entity Type:Organization
Organization Name:BARTON CREEK CHIROPRACTIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-892-4445
Mailing Address - Street 1:1600 W 38TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6404
Mailing Address - Country:US
Mailing Address - Phone:512-892-4445
Mailing Address - Fax:512-892-4449
Practice Address - Street 1:1600 W 38TH ST STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6404
Practice Address - Country:US
Practice Address - Phone:512-892-4445
Practice Address - Fax:512-892-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty