Provider Demographics
NPI:1326569880
Name:HEALTH RESOURCES AND REHAB CHIROPRACTIC WELLNESS
Entity Type:Organization
Organization Name:HEALTH RESOURCES AND REHAB CHIROPRACTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE-EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-725-7406
Mailing Address - Street 1:PO BOX 225843
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-5843
Mailing Address - Country:US
Mailing Address - Phone:832-725-7406
Mailing Address - Fax:800-381-9202
Practice Address - Street 1:400 N SAINT PAUL ST STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-6804
Practice Address - Country:US
Practice Address - Phone:832-725-7406
Practice Address - Fax:800-381-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4488111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTIN