Provider Demographics
NPI:1376711614
Name:STANGENWALD ENT PA
Entity Type:Organization
Organization Name:STANGENWALD ENT PA
Other - Org Name:TOTAL BODY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANGENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-281-9040
Mailing Address - Street 1:466 MID CITIES BLVD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2430
Mailing Address - Country:US
Mailing Address - Phone:817-281-9040
Mailing Address - Fax:817-281-4249
Practice Address - Street 1:401 SW PLAZA
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016
Practice Address - Country:US
Practice Address - Phone:817-561-4907
Practice Address - Fax:817-561-6740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty