Provider Demographics
NPI:1265103618
Name:PURE ENERGY CHIROPRACTIC
Entity type:Organization
Organization Name:PURE ENERGY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-673-2027
Mailing Address - Street 1:141 SANGAREE DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2154
Mailing Address - Country:US
Mailing Address - Phone:801-672-2027
Mailing Address - Fax:
Practice Address - Street 1:2304 HANCOCK DR STE 7
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2540
Practice Address - Country:US
Practice Address - Phone:801-673-2027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty