NPIMap

Organization Active NPI

Wagenblast Chiropractic, PLLC

Doing business as Active Sports Therapy and Rehabilitation

  • Sports Physician Chiropractor
  • Round Rock, TX
National Provider Identifier
1235418666
Registry record updated Aug 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
9995 Issued in TX
Legal business name
WAGENBLAST CHIROPRACTIC, PLLC
Doing business as
Active Sports Therapy and Rehabilitation
Practice address
102 E Main St
Suite a
Round Rock, TX 78664-5200
Phone
(512) 284-9278
Fax
(512) 284-9283
NPI assigned
Aug 16, 2011
Last updated
Aug 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Seth Andrew Wagenblast, DCNPI 1821199126
Title
Owner
Phone
(512) 507-6681

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 9995 TX
Sports Physician Chiropractor 111NS0005X 9995 TX Primary
Rehabilitation Chiropractor 111NR0400X 9995 TX

Addresses

Primary practice location

102 E Main St
Suite a
Round Rock, TX 78664-5200

Mailing address

1111 Remington Dr
Leander, TX 78641-7799
Phone (512) 507-6681

Other names 1

  • Active Sports Therapy and Rehabilitation Doing business as

National Provider Directory

National Provider Directory

Locations

102 E Main St
Ste A
Round Rock, TX 78664
Phone (512) 284-9278

1315 Sam Bass Cir
Ste B
Round Rock, TX 78681

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313452800000",
    "number": "1235418666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 REMINGTON DR",
            "city": "LEANDER",
            "state": "TX",
            "postal_code": "786417799",
            "telephone_number": "512-507-6681",
            "fax_number": "512-284-9283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E MAIN ST",
            "address_2": "SUITE A",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786645200",
            "telephone_number": "512-284-9278",
            "fax_number": "512-284-9283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGENBLAST CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-16",
        "last_updated": "2011-08-16",
        "status": "A",
        "authorized_official_last_name": "WAGENBLAST",
        "authorized_official_first_name": "SETH",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-507-6681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "9995",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "TX",
            "license": "9995",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "TX",
            "license": "9995",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Sports Therapy and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Round Rock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.