Provider Demographics
NPI:1871744524
Name:ELEDGE FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:ELEDGE FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-396-8351
Mailing Address - Street 1:900 RR 620 S
Mailing Address - Street 2:STE C 209
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5615
Mailing Address - Country:US
Mailing Address - Phone:512-263-8008
Mailing Address - Fax:512-263-1769
Practice Address - Street 1:900 RR 620 S
Practice Address - Street 2:STE C 209
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5615
Practice Address - Country:US
Practice Address - Phone:512-263-8008
Practice Address - Fax:512-263-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 10686261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty