Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 12231 | TX |
Y | 111NR0400X | Rehabilitation Chiropractor | 12231 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 12231 | TX |
N | 111NX0100X | Occupational Health | 12231 | TX |
NPI | 1851735534 |
---|---|
Provider Name | Dr. Steven Kyle Wunnenberg |
First Address | Austin, TX 78752-1016 |
Second Address | Austin, TX 78752-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 24/04/2013 |