Provider Demographics
NPI:1669666400
Name:FIRST WELLNESS
Entity Type:Organization
Organization Name:FIRST WELLNESS
Other - Org Name:AUSTIN OPTIMAL WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-451-9655
Mailing Address - Street 1:7739 NORTHCROSS DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1700
Mailing Address - Country:US
Mailing Address - Phone:512-451-9655
Mailing Address - Fax:512-380-9599
Practice Address - Street 1:7739 NORTHCROSS DR
Practice Address - Street 2:SUITE J
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1700
Practice Address - Country:US
Practice Address - Phone:512-451-9655
Practice Address - Fax:512-380-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022JQOtherBCBS
TX00W047Medicare PIN