Provider Demographics
NPI:1295091981
Name:MAGNOLIA WELLNESS CENTER
Entity type:Organization
Organization Name:MAGNOLIA WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-833-0500
Mailing Address - Street 1:1846 INTERSTATE 10 S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4439
Mailing Address - Country:US
Mailing Address - Phone:409-833-0500
Mailing Address - Fax:409-842-3385
Practice Address - Street 1:1846 INTERSTATE 10 S
Practice Address - Street 2:SUITE 102
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4439
Practice Address - Country:US
Practice Address - Phone:409-833-0500
Practice Address - Fax:409-842-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty