Provider Demographics
NPI:1669650842
Name:TRIUNE A CREATING WELLNESS CENTER
Entity type:Organization
Organization Name:TRIUNE A CREATING WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:512-868-8900
Mailing Address - Street 1:1102 S AUSTIN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6756
Mailing Address - Country:US
Mailing Address - Phone:512-868-8900
Mailing Address - Fax:
Practice Address - Street 1:1102 S AUSTIN AVE STE 103
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6756
Practice Address - Country:US
Practice Address - Phone:512-868-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052LZOtherBCBS GROUP
TX00787XMedicare PIN