Provider Demographics
NPI:1912515404
Name:ROCKWALL COLONICS & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ROCKWALL COLONICS & WELLNESS CENTER LLC
Other - Org Name:ROCKWALL COMPLETE HEALING AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-771-8900
Mailing Address - Street 1:2455 RIDGE RD STE 151
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5538
Mailing Address - Country:US
Mailing Address - Phone:972-771-8900
Mailing Address - Fax:
Practice Address - Street 1:2455 RIDGE RD STE 151
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5538
Practice Address - Country:US
Practice Address - Phone:972-771-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care