Provider Demographics
NPI:1609181296
Name:PROFESSIONAL WELLNESS CENTERS, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUHYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-358-2225
Mailing Address - Street 1:1416 CAMPBELL RD
Mailing Address - Street 2:100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4752
Mailing Address - Country:US
Mailing Address - Phone:832-358-2225
Mailing Address - Fax:
Practice Address - Street 1:1416 CAMPBELL RD
Practice Address - Street 2:100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4752
Practice Address - Country:US
Practice Address - Phone:832-358-2225
Practice Address - Fax:832-358-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty