Provider Demographics
NPI:1023508827
Name:WHOLE LIFE FAMILY WELLNESS, LLC
Entity type:Organization
Organization Name:WHOLE LIFE FAMILY WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-429-1391
Mailing Address - Street 1:113 N BALLARD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4494
Mailing Address - Country:US
Mailing Address - Phone:972-429-1391
Mailing Address - Fax:
Practice Address - Street 1:113 N BALLARD AVE STE A
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4494
Practice Address - Country:US
Practice Address - Phone:972-429-1391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13108111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty