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Organization
TIFERET MEDICAL MANAGEMENT LLC
Active
Organization
TIFERET MEDICAL MANAGEMENT LLC
Active
Other names
Lakeline Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN RUSSELL GORE DC (OWNER)
(512) 264-4801
Entity
Organization
Contact information
Practice address
1400 BECKETT ST, AUSTIN, TX 78757-8302
(512) 264-4801
Mailing address
2307 S. LAKELINE BLVD, 700, CEDAR PARK, TX 78613
(512) 264-4801
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
13355
TX
Other
Enumeration date
03/13/2017
Last updated
09/08/2017
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