Provider Demographics
NPI:1154604460
Name:EBWE, EROMATA (DC,)
Entity type:Individual
Prefix:
First Name:EROMATA
Middle Name:
Last Name:EBWE
Suffix:
Gender:F
Credentials:DC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 FM 620 N
Mailing Address - Street 2:STE.2632
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-3502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8716 N MOPAC EXPY
Practice Address - Street 2:STE.340
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8327
Practice Address - Country:US
Practice Address - Phone:563-468-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor