Provider Demographics
NPI:1710093802
Name:WELLNESS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:WELLNESS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:LABUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-868-0252
Mailing Address - Street 1:2816 CENTRAL DRIVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-868-0252
Mailing Address - Fax:817-868-0245
Practice Address - Street 1:2816 CENTRAL DR
Practice Address - Street 2:SUITE 175
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-868-0252
Practice Address - Fax:817-868-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V5190OtherBCBS
TX0031NPOtherBCBS GROUP
TX00313HMedicare UPIN