Provider Demographics
NPI:1497476147
Name:GENERATIONAL HEALTH & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:GENERATIONAL HEALTH & WELLNESS CENTER LLC
Other - Org Name:GENERATIONAL FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO/OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-310-6291
Mailing Address - Street 1:875 S HEWITT DR STE 9
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3201
Mailing Address - Country:US
Mailing Address - Phone:254-310-6291
Mailing Address - Fax:
Practice Address - Street 1:875 S HEWITT DR STE 9
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3201
Practice Address - Country:US
Practice Address - Phone:254-310-6291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty