Provider Demographics
NPI:1942797766
Name:ERB FAMILY WELLNESS SOUTHLAKE LLC
Entity Type:Organization
Organization Name:ERB FAMILY WELLNESS SOUTHLAKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PINSON-ERB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-895-0075
Mailing Address - Street 1:255 S DENTON TAP RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5050
Mailing Address - Country:US
Mailing Address - Phone:972-556-9595
Mailing Address - Fax:
Practice Address - Street 1:1845 E SOUTHLAKE BLVD # 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:817-895-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX658421OtherMEDICARE