Provider Demographics
NPI:1376970202
Name:TEXARKANA HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:TEXARKANA HEALTH AND WELLNESS, LLC
Other - Org Name:UNITED HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-838-5883
Mailing Address - Street 1:1718 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2415
Mailing Address - Country:US
Mailing Address - Phone:903-838-5883
Mailing Address - Fax:903-223-9075
Practice Address - Street 1:1718 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2415
Practice Address - Country:US
Practice Address - Phone:903-838-5883
Practice Address - Fax:903-223-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11844305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization