MEDICARE: PHOENIX WELLNESS AND NUTRITION PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1508246257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX WELLNESS AND NUTRITION PLLC

Provider Business Mailing Address
First Line	:	33300 EGYPT LN
Second Line	:	STE. I-20
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-2739
Country	:	US
Telephone Number	:	832-914-7368
Fax Number	:	832-717-7621

Provider Business Practice Location Address
First Line	:	4706 FLEMING DOWNE LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-3829
Country	:	US
Telephone Number	:	832-914-7368
Fax Number	:	832-717-7621

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	LYNNETTE ORRICK
Credential	:	DC
Telephone Number	:	832-914-7368

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/11/2015

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