Provider Demographics
NPI:1841765773
Name:TERRELL CHIROPRACTIC AND WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:TERRELL CHIROPRACTIC AND WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:MCCLARY
Authorized Official - Last Name:WILD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-789-0549
Mailing Address - Street 1:1409 W MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2303
Mailing Address - Country:US
Mailing Address - Phone:972-563-1557
Mailing Address - Fax:
Practice Address - Street 1:1409 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2303
Practice Address - Country:US
Practice Address - Phone:972-563-1557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1982187381OtherPERSONAL NPI