Provider Demographics
NPI:1639449812
Name:SRB WELLNESS INC
Entity Type:Organization
Organization Name:SRB WELLNESS INC
Other - Org Name:ALLIANCE CHIROPRACTIC AND MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-281-0008
Mailing Address - Street 1:5710 WATAUGA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3022
Mailing Address - Country:US
Mailing Address - Phone:817-281-0008
Mailing Address - Fax:817-281-7333
Practice Address - Street 1:5710 WATAUGA RD
Practice Address - Street 2:SUITE A
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3022
Practice Address - Country:US
Practice Address - Phone:817-281-0008
Practice Address - Fax:817-281-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB148622Medicare PIN