Provider Demographics
NPI:1609425198
Name:GLASS HEALTH & WELLNESS,LLC
Entity Type:Organization
Organization Name:GLASS HEALTH & WELLNESS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-865-6135
Mailing Address - Street 1:5353 ALPHA RD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4357
Mailing Address - Country:US
Mailing Address - Phone:469-865-6135
Mailing Address - Fax:
Practice Address - Street 1:5353 ALPHA RD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4357
Practice Address - Country:US
Practice Address - Phone:972-440-9918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty