Provider Demographics
NPI:1255876223
Name:WM WELLNESS LLC
Entity type:Organization
Organization Name:WM WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMITRIOUS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-457-4350
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5722
Mailing Address - Country:US
Mailing Address - Phone:214-457-4350
Mailing Address - Fax:877-382-2846
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5722
Practice Address - Country:US
Practice Address - Phone:214-457-4350
Practice Address - Fax:877-382-2846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILMOREHANDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty