Provider Demographics
NPI:1679855068
Name:HENSON WELLNESS CENTER PC
Entity Type:Organization
Organization Name:HENSON WELLNESS CENTER PC
Other - Org Name:SOUTHWEST WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-461-6374
Mailing Address - Street 1:1216 FLORIDA DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2387
Mailing Address - Country:US
Mailing Address - Phone:817-461-6374
Mailing Address - Fax:817-461-8550
Practice Address - Street 1:1216 FLORIDA DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2387
Practice Address - Country:US
Practice Address - Phone:817-461-6374
Practice Address - Fax:817-461-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L13615Medicare UPIN
TX8F5887Medicare UPIN