Provider Demographics
NPI:1497176606
Name:PFLUGERVILLE WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:PFLUGERVILLE WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-251-9686
Mailing Address - Street 1:2415 PECAN ST W
Mailing Address - Street 2:STE 201
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3669
Mailing Address - Country:US
Mailing Address - Phone:512-251-9686
Mailing Address - Fax:512-251-9488
Practice Address - Street 1:2415 PECAN ST W
Practice Address - Street 2:STE 201
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3669
Practice Address - Country:US
Practice Address - Phone:512-251-9686
Practice Address - Fax:512-251-9488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty