Provider Demographics
NPI:1205175015
Name:HEALTHSOURCE OF FT WORTH-WEST 7TH
Entity type:Organization
Organization Name:HEALTHSOURCE OF FT WORTH-WEST 7TH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRONSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-392-1232
Mailing Address - Street 1:3330 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2715
Mailing Address - Country:US
Mailing Address - Phone:806-392-1232
Mailing Address - Fax:806-392-1232
Practice Address - Street 1:3330 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2715
Practice Address - Country:US
Practice Address - Phone:806-392-1232
Practice Address - Fax:806-392-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty