Provider Demographics
NPI:1780851816
Name:MARSHALL WELLNESS GROUP
Entity Type:Organization
Organization Name:MARSHALL WELLNESS GROUP
Other - Org Name:MARSHALL BACK & BODY WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-522-1726
Mailing Address - Street 1:PO BOX 131058
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77219-1058
Mailing Address - Country:US
Mailing Address - Phone:713-522-1726
Mailing Address - Fax:713-522-7163
Practice Address - Street 1:510 WAUGH DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-2002
Practice Address - Country:US
Practice Address - Phone:713-522-1726
Practice Address - Fax:713-522-7163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL WELLNESS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6456111N00000X
TXM7449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty