Provider Demographics
NPI:1942239470
Name:MCKIRDY, TRIA NIETSCHE (DC)
Entity Type:Individual
Prefix:DR
First Name:TRIA
Middle Name:NIETSCHE
Last Name:MCKIRDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TRIA
Other - Middle Name:KRISTIN
Other - Last Name:NIETSCHE-MCKIRDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8600 GRANADA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-1443
Mailing Address - Country:US
Mailing Address - Phone:512-299-8331
Mailing Address - Fax:512-551-9445
Practice Address - Street 1:802 W SAINT ELMO RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1153
Practice Address - Country:US
Practice Address - Phone:512-299-8331
Practice Address - Fax:512-551-9445
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVO9468Medicare UPIN