Provider Demographics
NPI:1891357026
Name:SPINE HEALTH AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:SPINE HEALTH AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-498-4866
Mailing Address - Street 1:600 E JOHN CARPENTER FWY STE 125
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4299
Mailing Address - Country:US
Mailing Address - Phone:972-556-5667
Mailing Address - Fax:
Practice Address - Street 1:600 E JOHN CARPENTER FWY STE 125
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4299
Practice Address - Country:US
Practice Address - Phone:972-556-5667
Practice Address - Fax:972-635-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty