Provider Demographics
NPI:1285211771
Name:ELDORADO TOTAL WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:ELDORADO TOTAL WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-598-1200
Mailing Address - Street 1:5000 ELDORADO
Mailing Address - Street 2:BOX 150-153
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033
Mailing Address - Country:US
Mailing Address - Phone:469-598-1200
Mailing Address - Fax:972-637-9272
Practice Address - Street 1:5000 ELDORADO PKWY STE 420
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8612
Practice Address - Country:US
Practice Address - Phone:469-598-1200
Practice Address - Fax:972-637-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty