Provider Demographics
NPI:1942489653
Name:ALVARADO CHIROPRACTIC WELLNESS CENTER PA
Entity Type:Organization
Organization Name:ALVARADO CHIROPRACTIC WELLNESS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-559-3880
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424-0775
Mailing Address - Country:US
Mailing Address - Phone:817-783-7788
Mailing Address - Fax:817-783-7799
Practice Address - Street 1:110 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:ALVARADO
Practice Address - State:TX
Practice Address - Zip Code:76009-4319
Practice Address - Country:US
Practice Address - Phone:817-783-7788
Practice Address - Fax:817-783-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty