Provider Demographics
NPI:1184900359
Name:BOTTS, TREVOR JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:JOHN
Last Name:BOTTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 N HIGHWAY 183
Mailing Address - Street 2:STE L4
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1884
Mailing Address - Country:US
Mailing Address - Phone:512-257-3627
Mailing Address - Fax:512-257-9870
Practice Address - Street 1:13740 N HIGHWAY 183
Practice Address - Street 2:STE L4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1884
Practice Address - Country:US
Practice Address - Phone:512-257-3627
Practice Address - Fax:512-257-9870
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor