Provider Demographics
NPI:1700428901
Name:NORTH TEXAS INJURY AND WELLNESS PLLC
Entity Type:Organization
Organization Name:NORTH TEXAS INJURY AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-723-4441
Mailing Address - Street 1:6116 DAKBEND TRAIL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3926
Mailing Address - Country:US
Mailing Address - Phone:817-346-7800
Mailing Address - Fax:817-346-7804
Practice Address - Street 1:6431 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-2777
Practice Address - Country:US
Practice Address - Phone:817-738-9777
Practice Address - Fax:817-738-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty