Provider Demographics
NPI:1407251101
Name:WADLEY, ARTELIA (DC)
Entity Type:Individual
Prefix:
First Name:ARTELIA
Middle Name:
Last Name:WADLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 RIVER RUN STE 911
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6555
Mailing Address - Country:US
Mailing Address - Phone:817-888-8642
Mailing Address - Fax:817-349-0982
Practice Address - Street 1:1701 RIVER RUN STE 911
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-888-8642
Practice Address - Fax:817-349-0982
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor