Provider Demographics
NPI:1558771790
Name:BLESSED FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:BLESSED FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:ANNIE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-876-3574
Mailing Address - Street 1:101 W COOPERATIVE WAY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-8208
Mailing Address - Country:US
Mailing Address - Phone:512-868-6900
Mailing Address - Fax:512-868-6995
Practice Address - Street 1:101 W COOPERATIVE WAY
Practice Address - Street 2:SUITE 235
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-8208
Practice Address - Country:US
Practice Address - Phone:512-868-6900
Practice Address - Fax:512-868-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12578302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization