Provider Demographics
NPI:1508246257
Name:PHOENIX WELLNESS AND NUTRITION PLLC
Entity Type:Organization
Organization Name:PHOENIX WELLNESS AND NUTRITION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-914-7368
Mailing Address - Street 1:33300 EGYPT LN
Mailing Address - Street 2:STE. I-20
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2739
Mailing Address - Country:US
Mailing Address - Phone:832-914-7368
Mailing Address - Fax:832-717-7621
Practice Address - Street 1:4706 FLEMING DOWNE LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3829
Practice Address - Country:US
Practice Address - Phone:832-914-7368
Practice Address - Fax:832-717-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty