1578707618 NPI number — FAMILY WELLNESS CHIROPRACTIC CENTER, INC.

Table of content: (NPI 1578707618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578707618 NPI number — FAMILY WELLNESS CHIROPRACTIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY WELLNESS CHIROPRACTIC CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578707618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1702 N COLLINS BLVD
Provider Second Line Business Mailing Address:
SUITE 161
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75080-3566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-437-4944
Provider Business Mailing Address Fax Number:
972-437-0534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1702 N COLLINS BLVD
Provider Second Line Business Practice Location Address:
SUITE 161
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75080-3566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-437-4944
Provider Business Practice Location Address Fax Number:
972-437-0534
Provider Enumeration Date:
04/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HAHN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-437-4944

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7292 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 605802 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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