Individual
CAROL MARIE AMBROSIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC DAC BSP
Contact information
Practice address
20811 DAWN DR, SUITE 505, LAGO VISTA, TX 78645
(512) 267-3477
(512) 267-3948
Mailing address
20811 DAWN DR, SUITE 505, LAGO VISTA, TX 78645
(512) 267-3477
(512) 267-3948
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6193
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
628270
UNITED HEALTH CARE
—
Enumeration date
08/22/2006
Last updated
07/08/2007
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