Provider Demographics
NPI:1851693618
Name:MICHAEL D. VENNELL DC PA
Entity Type:Organization
Organization Name:MICHAEL D. VENNELL DC PA
Other - Org Name:SPINE & SPORTS WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:VENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-356-7291
Mailing Address - Street 1:3501 SONCY ST. STE #1
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6405
Mailing Address - Country:US
Mailing Address - Phone:806-356-7291
Mailing Address - Fax:806-553-1598
Practice Address - Street 1:3501 SONCY ST. STE #1
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-356-7291
Practice Address - Fax:806-553-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11599302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization