Basic Information
| Provider Information | |||||||||
| NPI: | 1144618109 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAMSON COUNTY CHIROPRACTIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2051 GATTIS SCHOOL RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786647441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122164032 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2051 GATTIS SCHOOL RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786647441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122164032 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2014 | ||||||||
| LastUpdateDate: | 12/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5122164032 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 11561 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.