Organization
FIRE OF LIFE CHIROPRACTIC PLLC
Active
Other names
Fire of Life Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KURT VANESSA EDEKER (OFFICE MANAGER)
(512) 608-9121
Entity
Organization
Contact information
Practice address
1200 LAKEWAY DR, 17B, LAKEWAY, TX 78734-4400
(512) 608-9121
(512) 608-9121
Mailing address
1200 LAKEWAY DR, 17B, LAKEWAY, TX 78734-4400
(512) 608-9121
(512) 608-9121
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
9962
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00641Y
MEDICARE LEGACY #
TX
01
—
1003096975
INDIVIDUAL NPI
TX
01
—
1235311721
GROUP NPI
—
Enumeration date
11/27/2007
Last updated
07/31/2008
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