Provider Demographics
NPI:1114250792
Name:NLC REHAB AND WELLNESS INC
Entity Type:Organization
Organization Name:NLC REHAB AND WELLNESS INC
Other - Org Name:NEW LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GONYEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-899-8002
Mailing Address - Street 1:2628 LONG PRAIRIE RD
Mailing Address - Street 2:#105
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4839
Mailing Address - Country:US
Mailing Address - Phone:972-899-8002
Mailing Address - Fax:
Practice Address - Street 1:2628 LONG PRAIRIE RD
Practice Address - Street 2:#105
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4839
Practice Address - Country:US
Practice Address - Phone:972-899-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty