Provider Demographics
NPI:1699024752
Name:MAULDIN HEINRICH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MAULDIN HEINRICH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:MAULDIN
Authorized Official - Last Name:MCMINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-795-0707
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD STE O1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8664
Mailing Address - Country:US
Mailing Address - Phone:512-795-0707
Mailing Address - Fax:512-795-7742
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE O1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8664
Practice Address - Country:US
Practice Address - Phone:512-795-0707
Practice Address - Fax:512-795-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 5085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603163Medicare PIN