Provider Demographics
NPI:1760620686
Name:UNIVERSITY SPINE & SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:UNIVERSITY SPINE & SPORTS MEDICINE INC
Other - Org Name:ELENA VILLANUEVA OLCOTT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:VILLANUEVA
Authorized Official - Last Name:OLCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-600-4848
Mailing Address - Street 1:2911 MEDICAL ARTS ST.
Mailing Address - Street 2:#13
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3302
Mailing Address - Country:US
Mailing Address - Phone:512-600-4848
Mailing Address - Fax:512-628-0182
Practice Address - Street 1:2911 MEDICAL ARTS ST.
Practice Address - Street 2:#13
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3302
Practice Address - Country:US
Practice Address - Phone:512-600-4848
Practice Address - Fax:512-628-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9759111NI0900X
TX9663111NR0400X
TX10381111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty