Provider Demographics
NPI:1619004538
Name:TEXAS ALPHA WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:TEXAS ALPHA WELLNESS CENTER, PC
Other - Org Name:ALPHA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-251-9828
Mailing Address - Street 1:1340 S MAIN STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7509
Mailing Address - Country:US
Mailing Address - Phone:817-251-9828
Mailing Address - Fax:817-251-9829
Practice Address - Street 1:1340 S MAIN STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7509
Practice Address - Country:US
Practice Address - Phone:817-251-9828
Practice Address - Fax:817-251-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148301OtherMEDICARE PTAN