Provider Demographics
NPI:1023341476
Name:HAWTHORNE CHIROPRACTIC
Entity type:Organization
Organization Name:HAWTHORNE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-448-2225
Mailing Address - Street 1:3300 BEE CAVE RD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6600
Mailing Address - Country:US
Mailing Address - Phone:512-448-2225
Mailing Address - Fax:512-329-9669
Practice Address - Street 1:3300 BEE CAVE RD
Practice Address - Street 2:SUITE 390
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6600
Practice Address - Country:US
Practice Address - Phone:512-448-2225
Practice Address - Fax:512-329-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF007007OtherFACILITY LICENSE