Provider Demographics
NPI:1205668316
Name:4 WELLNESS LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:4 WELLNESS LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-985-1115
Mailing Address - Street 1:2110 RR 620 S UNIT 341825
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-0274
Mailing Address - Country:US
Mailing Address - Phone:512-553-5186
Mailing Address - Fax:512-368-2580
Practice Address - Street 1:115 SUNDANCE PKWY STE 505
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7927
Practice Address - Country:US
Practice Address - Phone:512-985-1115
Practice Address - Fax:512-368-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty