Provider Demographics
NPI:1932438231
Name:ENLIGHTEN CHIROPRACTIC & ACUPUNCTURE
Entity Type:Organization
Organization Name:ENLIGHTEN CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VANDARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUNARATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-458-1025
Mailing Address - Street 1:15501 ADLONG DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3315
Mailing Address - Country:US
Mailing Address - Phone:817-458-1025
Mailing Address - Fax:888-848-3798
Practice Address - Street 1:2238 MICHIGAN AVE
Practice Address - Street 2:STE D
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5945
Practice Address - Country:US
Practice Address - Phone:817-458-1025
Practice Address - Fax:888-848-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty