Provider Demographics
NPI:1861686339
Name:360 CHIROPRACTIC & WELLNESS PLLC
Entity Type:Organization
Organization Name:360 CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:MONESA GONSTEAD ENTERPRISES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER - LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-474-6133
Mailing Address - Street 1:8837 LEBANON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8659
Mailing Address - Country:US
Mailing Address - Phone:469-474-6133
Mailing Address - Fax:214-618-8089
Practice Address - Street 1:8837 LEBANON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8659
Practice Address - Country:US
Practice Address - Phone:469-474-6133
Practice Address - Fax:214-618-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty