Provider Demographics
NPI:1528425279
Name:ROUND ROCK HEALTHCARE & CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:ROUND ROCK HEALTHCARE & CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORREIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-388-3880
Mailing Address - Street 1:301 HESTERS CROSSING RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6946
Mailing Address - Country:US
Mailing Address - Phone:512-388-3880
Mailing Address - Fax:512-388-3946
Practice Address - Street 1:301 HESTERS CROSSING RD
Practice Address - Street 2:SUITE 212
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6946
Practice Address - Country:US
Practice Address - Phone:512-388-3880
Practice Address - Fax:512-388-3946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6655305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605583OtherMEDICARE PTAN