Provider Demographics
NPI:1275771438
Name:BELTON CHIROPRACTIC & WELLNESS, PLLC
Entity Type:Organization
Organization Name:BELTON CHIROPRACTIC & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-933-2273
Mailing Address - Street 1:325 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3162
Mailing Address - Country:US
Mailing Address - Phone:254-933-2273
Mailing Address - Fax:254-933-2531
Practice Address - Street 1:325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3162
Practice Address - Country:US
Practice Address - Phone:254-933-2273
Practice Address - Fax:254-933-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7221OtherTEXAS STATE DC LICENSE 7221