Provider Demographics
NPI:1003200726
Name:ACTIVATED FAMILY CHIROPRACTIC & WELLNESS, PLLC
Entity type:Organization
Organization Name:ACTIVATED FAMILY CHIROPRACTIC & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SURACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-925-0384
Mailing Address - Street 1:13140 COIT RD STE 514
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5755
Mailing Address - Country:US
Mailing Address - Phone:972-925-0384
Mailing Address - Fax:972-925-9163
Practice Address - Street 1:13140 COIT RD STE 514
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5755
Practice Address - Country:US
Practice Address - Phone:972-925-0384
Practice Address - Fax:972-925-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty