Provider Demographics
NPI:1740329481
Name:UNIVERSITY CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:UNIVERSITY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DARROW
Authorized Official - Last Name:KANZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-480-8889
Mailing Address - Street 1:1111 W 24TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4655
Mailing Address - Country:US
Mailing Address - Phone:512-480-8889
Mailing Address - Fax:512-480-8899
Practice Address - Street 1:1111 W 24TH ST STE B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4655
Practice Address - Country:US
Practice Address - Phone:512-480-8889
Practice Address - Fax:512-480-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00146YMedicare PIN