| |
4634 W Gate Blvd Austin TX 78745-1461 | |
(512) 288-7000 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 4634 W Gate Blvd, Austin, Texas |
Authorized Official Name and Position | Brian Alan Clark (CHIROPRACTOR) |
Authorized Official Contact | 5122887000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4634 W Gate Blvd Austin TX 78745-1461 Ph: (512) 288-7000 | 4634 W Gate Blvd Austin TX 78745-1461 Ph: (512) 288-7000 |
NPI Number | 1952576019 |
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Provider Enumeration Date | 04/29/2008 |
Last Update Date | 02/01/2016 |
Medicare PECOS PAC ID | 2466736319 |
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Medicare Enrollment ID | O20170221002468 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952576019 | NPI | - | NPPES |
191247 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 10645 (Texas) | Primary |
Provider Name | Brian A Clark |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1023296977 PECOS PAC ID: 3274683917 Enrollment ID: I20090618000117 |
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