Provider Demographics
NPI:1801065834
Name:CHIROPRACTIC WELLNESS AND REHABILITATION P.A.
Entity type:Organization
Organization Name:CHIROPRACTIC WELLNESS AND REHABILITATION P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-514-9923
Mailing Address - Street 1:5708 COLLEYVILLE BLVD
Mailing Address - Street 2:B
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6064
Mailing Address - Country:US
Mailing Address - Phone:817-514-9923
Mailing Address - Fax:817-514-6368
Practice Address - Street 1:5708 COLLEYVILLE BLVD
Practice Address - Street 2:B
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6064
Practice Address - Country:US
Practice Address - Phone:817-514-9923
Practice Address - Fax:817-514-6368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4901111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty