Provider Demographics
NPI:1679350086
Name:WELLNESS INTENTIONALLY LIVED DAILY PLLC
Entity Type:Organization
Organization Name:WELLNESS INTENTIONALLY LIVED DAILY PLLC
Other - Org Name:ABARIM WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WELDON
Authorized Official - Last Name:STACEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-218-3161
Mailing Address - Street 1:11517 CERES ST
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-3670
Mailing Address - Country:US
Mailing Address - Phone:254-900-6695
Mailing Address - Fax:
Practice Address - Street 1:7215 BOSQUE BLVD STE 131
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4020
Practice Address - Country:US
Practice Address - Phone:254-218-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty