Provider Demographics
NPI:1447538806
Name:CENTEX SPINE, LLC
Entity type:Organization
Organization Name:CENTEX SPINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-442-2727
Mailing Address - Street 1:PO BOX 5927
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78763-5927
Mailing Address - Country:US
Mailing Address - Phone:512-442-2727
Mailing Address - Fax:512-442-2728
Practice Address - Street 1:4316 JAMES CASEY ST
Practice Address - Street 2:BLDG B, SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-442-2727
Practice Address - Fax:512-442-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052WVOtherBCBS GROUP PROVIDER RECORD ID