Provider Demographics
NPI:1114614005
Name:VISIONARY IMAGING & WELLNESS LLC
Entity Type:Organization
Organization Name:VISIONARY IMAGING & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHERO
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, CHC
Authorized Official - Phone:817-894-9436
Mailing Address - Street 1:3575 STORY RD W SUITE 130
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3427
Mailing Address - Country:US
Mailing Address - Phone:214-458-0999
Mailing Address - Fax:
Practice Address - Street 1:3575 STORY RD W SUITE 130
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3427
Practice Address - Country:US
Practice Address - Phone:214-458-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty