Provider Demographics
NPI:1245338011
Name:MASON, MARY (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 BLANCO ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1208 SHELLEY AVE
Practice Address - Street 2:A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4108
Practice Address - Country:US
Practice Address - Phone:512-947-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor