Healthcare Provider Details

I. General information

NPI: 1770922999
Provider Name (Legal Business Name): WHOLISTIC WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 BAYLOR ST STE 100
AUSTIN TX
78703-4122
US

IV. Provider business mailing address

1211 BAYLOR ST STE 100
AUSTIN TX
78703-4122
US

V. Phone/Fax

Practice location:
  • Phone: 972-839-0262
  • Fax: 877-828-6193
Mailing address:
  • Phone: 972-839-0262
  • Fax: 877-828-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11025
License Number StateTX

VIII. Authorized Official

Name: DR. ERIKA LEIGH YANCEY
Title or Position: OWNER
Credential: DC
Phone: 972-839-0262