Provider Demographics
NPI:1689112740
Name:KATY WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:KATY WELLNESS CENTER LLC
Other - Org Name:KATY WELLNESS CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:KONESHECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-835-1171
Mailing Address - Street 1:1817 PINE NEEDLE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1665
Mailing Address - Country:US
Mailing Address - Phone:832-835-1171
Mailing Address - Fax:832-415-0457
Practice Address - Street 1:24530 KINGSLAND BLVD STE B
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3429
Practice Address - Country:US
Practice Address - Phone:832-835-1171
Practice Address - Fax:832-415-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty