Basic Information
| Provider Information | |||||||||
| NPI: | 1720474570 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR. B. AUSTIN'S CHIROPRACTIC GRP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4861 CONVOY ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921111610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192994847 | ||||||||
| FaxNumber: | 8585658504 | ||||||||
| Practice Location | |||||||||
| Address1: | 4861 CONVOY ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921111610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192994847 | ||||||||
| FaxNumber: | 8585658504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | AUSTIN | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | CONANT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6192994847 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC27717 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.