Provider Demographics
NPI:1295246478
Name:NEW YOU CHIROPRACTIC WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:NEW YOU CHIROPRACTIC WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:682-429-7699
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1213
Mailing Address - Country:US
Mailing Address - Phone:817-591-4900
Mailing Address - Fax:817-591-4730
Practice Address - Street 1:550 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CREEDE
Practice Address - State:CO
Practice Address - Zip Code:81130
Practice Address - Country:US
Practice Address - Phone:682-429-7699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0012525261Q00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty