Provider Demographics
NPI:1982300315
Name:TWIN LAKES FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:TWIN LAKES FAMILY CHIROPRACTIC PLLC
Other - Org Name:MAXLIVING CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER/AO
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-434-2947
Mailing Address - Street 1:12314 N INTERSTATE 35 STE 108
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-1349
Mailing Address - Country:US
Mailing Address - Phone:512-717-6597
Mailing Address - Fax:
Practice Address - Street 1:12314 N INTERSTATE 35 STE 108
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1349
Practice Address - Country:US
Practice Address - Phone:512-717-6597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty