Provider Demographics
NPI:1578239877
Name:YOUR WELLNESS CLINICS
Entity Type:Organization
Organization Name:YOUR WELLNESS CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JADEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-618-7667
Mailing Address - Street 1:10007 BLUEWATER TER
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5094
Mailing Address - Country:US
Mailing Address - Phone:817-618-7667
Mailing Address - Fax:817-618-7667
Practice Address - Street 1:4301 SATURN RD STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5323
Practice Address - Country:US
Practice Address - Phone:817-618-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty