Organization
WAGENBLAST CHIROPRACTIC, PLLC
Active
Other names
Active Sports Therapy and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SETH ANDREW WAGENBLAST DC (OWNER)
(512) 507-6681
Entity
Organization
Contact information
Practice address
102 E MAIN ST, SUITE A, ROUND ROCK, TX 78664-5200
(512) 284-9278
(512) 284-9283
Mailing address
1111 REMINGTON DR, LEANDER, TX 78641-7799
(512) 507-6681
(512) 284-9283
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
9995
TX
111NR0400X
Rehabilitation Chiropractor
9995
TX
111NS0005X
Sports Physician Chiropractor
Primary
9995
TX
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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