Provider Demographics
NPI:1205004744
Name:NORTH TEXAS SPINAL HEALTH & WELLNESS, INC.
Entity Type:Organization
Organization Name:NORTH TEXAS SPINAL HEALTH & WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-712-5556
Mailing Address - Street 1:425 OLD NEWMAN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4308
Mailing Address - Country:US
Mailing Address - Phone:972-712-5556
Mailing Address - Fax:972-712-5579
Practice Address - Street 1:425 OLD NEWMAN RD
Practice Address - Street 2:STE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4308
Practice Address - Country:US
Practice Address - Phone:972-712-5556
Practice Address - Fax:972-712-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011RPOtherBCBS
TX0011RPOtherBCBS