Provider Demographics
NPI:1770377202
Name:POTTS, MALLORY LOUISE (DC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:LOUISE
Last Name:POTTS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 VEGA AVE APT 3204
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-5820
Mailing Address - Country:US
Mailing Address - Phone:210-386-2636
Mailing Address - Fax:
Practice Address - Street 1:225 S COMMONS FORD RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-4004
Practice Address - Country:US
Practice Address - Phone:512-524-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor