Provider Demographics
NPI:1669858353
Name:PEACHWOOD WELLNESS PLLC
Entity Type:Organization
Organization Name:PEACHWOOD WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:210-701-1509
Mailing Address - Street 1:8301 BROADWAY
Mailing Address - Street 2:SUITE 422
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-701-1509
Mailing Address - Fax:
Practice Address - Street 1:8301 BROADWAY
Practice Address - Street 2:SUITE 422
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-701-1509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty