Provider Demographics
NPI:1093028755
Name:SCIENCE OF WELLNESS
Entity Type:Organization
Organization Name:SCIENCE OF WELLNESS
Other - Org Name:GATEWOOD WELLNESS CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:GATEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-704-1890
Mailing Address - Street 1:8811 TEEL PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4427
Mailing Address - Country:US
Mailing Address - Phone:972-704-1890
Mailing Address - Fax:
Practice Address - Street 1:8811 TEEL PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-704-1890
Practice Address - Fax:972-704-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11587111N00000X
TX10591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0044TYOtherBCBS
TX8CN790OtherBCBS
TX8CN791OtherBCBS
TX1093028755OtherBCBS