Provider Demographics
NPI:1851707699
Name:FEDESNA CHIROPRACTIC
Entity Type:Organization
Organization Name:FEDESNA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:FEDESNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-835-1182
Mailing Address - Street 1:8740 N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5440
Mailing Address - Country:US
Mailing Address - Phone:512-835-1182
Mailing Address - Fax:512-835-1888
Practice Address - Street 1:8740 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5440
Practice Address - Country:US
Practice Address - Phone:512-835-1182
Practice Address - Fax:512-835-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13244Medicare UPIN