Basic Information
| Provider Information | |||||||||
| NPI: | 1659919546 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUSTIN INTEGRATIVE SPINE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2510 TRAIL OF THE MADRONES | ||||||||
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| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787462341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122124865 | ||||||||
| FaxNumber: | 7372202520 | ||||||||
| Practice Location | |||||||||
| Address1: | 5656 BEE CAVES ROAD | ||||||||
| Address2: | SUITE C-101 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122124865 | ||||||||
| FaxNumber: | 7372202520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2019 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | MADERA | ||||||||
| AuthorizedOfficialFirstName: | MARCELLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | NEUROSURGEON | ||||||||
| AuthorizedOfficialTelephone: | 5122124865 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.