Organization Active NPI

Healthsource of Cedar Park, LLC

  • Chiropractor
  • Cedar Park, TX
National Provider Identifier
1366796401
Registry record updated Nov 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
11209 Issued in TX
Legal business name
HEALTHSOURCE OF CEDAR PARK, LLC
Practice address
201 S Lakeline Blvd
Suite 204
Cedar Park, TX 78613-2718
Phone
(512) 672-8408
NPI assigned
Oct 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2012

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

Authorized official

Name
Dr. Alexander C Klein, D.C.NPI 1932431715
Title
Owner/Authorized Official
Phone
(512) 740-6433

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 11209 TX Primary

Addresses

Primary practice location

201 S Lakeline Blvd
Suite 204
Cedar Park, TX 78613-2718

Mailing address

201 S Lakeline Blvd
Suite 204
Cedar Park, TX 78613-2718
Phone (512) 672-8408

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130530000571 TX Part B Supplier - Clinic/Group Practice 3173761228 Receives reassigned benefits from 1 practitioner
Practice locations: Cedar Park, TX

National Provider Directory

National Provider Directory

Locations

1075 N Lakeline Blvd
Ste 108
Cedar Park, TX 78613
Phone (512) 501-6941

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1351209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352851200000",
    "number": "1366796401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S LAKELINE BLVD",
            "address_2": "SUITE 204",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132718",
            "telephone_number": "512-672-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S LAKELINE BLVD",
            "address_2": "SUITE 204",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132718",
            "telephone_number": "512-672-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF CEDAR PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-26",
        "last_updated": "2012-11-14",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "512-740-6433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "11209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.