MEDICARE: INFINITY WELLNESS CENTER

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	10348	TX

General Provider Information

NPI Number	:	1619100658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY WELLNESS CENTER

Provider Business Mailing Address
First Line	:	205 WILD BASIN RD STE 2B
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-3304
Country	:	US
Telephone Number	:	512-328-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 WILD BASIN RD STE 2B
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-3304
Country	:	US
Telephone Number	:	512-328-0505
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TENESHA M WEINE
Credential	:	DC
Telephone Number	:	281-808-1982

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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