Provider Demographics
NPI:1821320672
Name:GANA SPECIFIC CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:GANA SPECIFIC CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-829-1549
Mailing Address - Street 1:1825 FORTVIEW RD STE 104
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7600
Mailing Address - Country:US
Mailing Address - Phone:512-829-1549
Mailing Address - Fax:
Practice Address - Street 1:1825 FORTVIEW RD STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7600
Practice Address - Country:US
Practice Address - Phone:512-829-1549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty