Provider Demographics
NPI:1043468408
Name:ABUNDANT WELLNESS PC
Entity Type:Organization
Organization Name:ABUNDANT WELLNESS PC
Other - Org Name:WELL SPINE AT VISTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-840-2520
Mailing Address - Street 1:1919 S. SHILOH
Mailing Address - Street 2:STE 107
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-8234
Mailing Address - Country:US
Mailing Address - Phone:972-840-2520
Mailing Address - Fax:972-840-2435
Practice Address - Street 1:1919 S. SHILOH
Practice Address - Street 2:STE 107
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8234
Practice Address - Country:US
Practice Address - Phone:972-840-2520
Practice Address - Fax:972-840-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608122OtherBCBS
TX611707Medicare PIN
TX608122OtherBCBS