Provider Demographics
NPI:1982128484
Name:VAN BELJON LLC
Entity Type:Organization
Organization Name:VAN BELJON LLC
Other - Org Name:SPA BY DIVINE AND WELLNESS INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:VAN BELJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-673-2111
Mailing Address - Street 1:1124 GLADE RD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-673-2111
Mailing Address - Fax:
Practice Address - Street 1:1124 GLADE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-673-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty