Provider Demographics
NPI:1124243720
Name:TOTAL HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:TOTAL HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-419-0330
Mailing Address - Street 1:7301 BURNET RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2250
Mailing Address - Country:US
Mailing Address - Phone:512-419-0330
Mailing Address - Fax:512-419-0919
Practice Address - Street 1:7301 BURNET RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-2250
Practice Address - Country:US
Practice Address - Phone:512-419-0330
Practice Address - Fax:512-419-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF006749261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610847Medicare ID - Type Unspecified