Healthcare Provider Details

I. General information

NPI: 1295246478
Provider Name (Legal Business Name): NEW YOU CHIROPRACTIC WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 05/25/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 AIRPORT RD
CREEDE CO
81130
US

IV. Provider business mailing address

PO BOX 1213
COLLEYVILLE TX
76034-1213
US

V. Phone/Fax

Practice location:
  • Phone: 682-429-7699
  • Fax:
Mailing address:
  • Phone: 817-591-4900
  • Fax: 817-591-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberF0012525
License Number StateTX

VIII. Authorized Official

Name: DR. TONY KELSOE
Title or Position: COO
Credential: DC
Phone: 682-429-7699