Provider Demographics
NPI:1770795783
Name:TREE OF LIFE CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:TREE OF LIFE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-547-7234
Mailing Address - Street 1:309 S JUPITER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 S JUPITER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3052
Practice Address - Country:US
Practice Address - Phone:214-547-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020LTOtherBCBS GRP
TX1770795783OtherNPI GRP
TX8P1151OtherBCBS INDIVIDUAL
TX1902881865OtherINDIVIDUAL NPI
TX1770795783OtherNPI GRP
TX8P1151OtherBCBS INDIVIDUAL