Provider Demographics
NPI:1649654120
Name:LAKEWOOD WELLNESS LLC
Entity type:Organization
Organization Name:LAKEWOOD WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-821-2525
Mailing Address - Street 1:6333 E MOCKINGBIRD LN STE 260
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2368
Mailing Address - Country:US
Mailing Address - Phone:214-821-2525
Mailing Address - Fax:
Practice Address - Street 1:6333 E MOCKINGBIRD LN STE 260
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2368
Practice Address - Country:US
Practice Address - Phone:214-821-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty