Provider Demographics
NPI:1043615362
Name:COMPLETE CHIROPRACTIC WELLNESS AD REHAB PLLC
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC WELLNESS AD REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWASELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-620-3414
Mailing Address - Street 1:1000 AUSTIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 AUSTIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5275
Practice Address - Country:US
Practice Address - Phone:281-239-6502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty