Provider Demographics
NPI:1669624409
Name:BORBON CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:BORBON CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:BORBON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-306-9800
Mailing Address - Street 1:5656 BEE CAVES RD
Mailing Address - Street 2:SUITE K201
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-306-9800
Mailing Address - Fax:512-306-9818
Practice Address - Street 1:5656 BEE CAVES RD
Practice Address - Street 2:SUITE K201
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-306-9800
Practice Address - Fax:512-306-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9945111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV04296OtherUPIN
TX1558545228OtherNPI