Provider Demographics
NPI:1114633294
Name:NATIVE CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:NATIVE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:AZCARATE - SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:915-667-0096
Mailing Address - Street 1:4215 MUNGER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-4417
Mailing Address - Country:US
Mailing Address - Phone:915-667-0096
Mailing Address - Fax:
Practice Address - Street 1:3102 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6025
Practice Address - Country:US
Practice Address - Phone:469-291-9129
Practice Address - Fax:214-821-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14692OtherCHIROPRACTOR- 111N00000X