Provider Demographics
NPI:1679566376
Name:SOUTHWESTERN CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:SOUTHWESTERN CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHARINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOLAN-BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-429-8228
Mailing Address - Street 1:2610 W FM 544
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4938
Mailing Address - Country:US
Mailing Address - Phone:972-429-8228
Mailing Address - Fax:972-429-8229
Practice Address - Street 1:2610 W FM 544
Practice Address - Street 2:SUITE 200
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4938
Practice Address - Country:US
Practice Address - Phone:972-429-8228
Practice Address - Fax:972-429-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91265Medicare UPIN
8897B9Medicare ID - Type Unspecified