Provider Demographics
NPI:1558327585
Name:BAGLEY CHIROPRACTIC & WELLNESS CENTER P.A.
Entity Type:Organization
Organization Name:BAGLEY CHIROPRACTIC & WELLNESS CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-263-0040
Mailing Address - Street 1:3821 JUNIPER TRCE
Mailing Address - Street 2:STE. 207
Mailing Address - City:BEE CAVES
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5506
Mailing Address - Country:US
Mailing Address - Phone:512-263-0040
Mailing Address - Fax:512-263-0026
Practice Address - Street 1:3821 JUNIPER TRCE
Practice Address - Street 2:STE. 207
Practice Address - City:BEE CAVES
Practice Address - State:TX
Practice Address - Zip Code:78738-5506
Practice Address - Country:US
Practice Address - Phone:512-263-0040
Practice Address - Fax:512-263-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty