Provider Demographics
NPI:1831294263
Name:COWELL GROUP INC
Entity Type:Organization
Organization Name:COWELL GROUP INC
Other - Org Name:PRIME LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:972-424-2225
Mailing Address - Street 1:2504 AVE K
Mailing Address - Street 2:STE 500
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5341
Mailing Address - Country:US
Mailing Address - Phone:972-424-2225
Mailing Address - Fax:972-424-7709
Practice Address - Street 1:2504 AVE K
Practice Address - Street 2:STE 500
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5341
Practice Address - Country:US
Practice Address - Phone:972-424-2225
Practice Address - Fax:972-424-7709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COWELL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF006625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041MNOtherBLUE CROSS
TX00379ZMedicare PIN