Provider Demographics
NPI:1043706344
Name:ACC-GEORGETOWN LLC
Entity type:Organization
Organization Name:ACC-GEORGETOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-680-6479
Mailing Address - Street 1:1905 BANDERA CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5623
Mailing Address - Country:US
Mailing Address - Phone:512-653-9321
Mailing Address - Fax:
Practice Address - Street 1:3007 DAWN DR STE 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2864
Practice Address - Country:US
Practice Address - Phone:512-863-7000
Practice Address - Fax:512-231-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty