Provider Demographics
NPI:1508459082
Name:WCCW FLINT, LLC
Entity Type:Organization
Organization Name:WCCW FLINT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-339-0010
Mailing Address - Street 1:21721 PAGOSA RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-4109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20071 STATE HIGHWAY 155 S
Practice Address - Street 2:STE 2
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762
Practice Address - Country:US
Practice Address - Phone:903-339-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty