Provider Demographics
NPI:1093188369
Name:FULL CIRCLE CHIROPRACTIC AND WELLNESS CENTER, LLC.
Entity Type:Organization
Organization Name:FULL CIRCLE CHIROPRACTIC AND WELLNESS CENTER, LLC.
Other - Org Name:FULL CIRCLE CHIROPRACTIC AND WELLNESS CENTER, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TE'LLA
Authorized Official - Middle Name:DANNETTE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:832-947-3715
Mailing Address - Street 1:10223 BROADWAY ST
Mailing Address - Street 2:SUITE P #422
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:832-947-3715
Mailing Address - Fax:888-599-0831
Practice Address - Street 1:2408 WHEELER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5250
Practice Address - Country:US
Practice Address - Phone:832-947-3715
Practice Address - Fax:888-599-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-08
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12085111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty