Healthcare Provider Details

I. General information

NPI: 1114250792
Provider Name (Legal Business Name): NLC REHAB AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 LONG PRAIRIE RD #105
FLOWER MOUND TX
75022-4839
US

IV. Provider business mailing address

2628 LONG PRAIRIE RD #105
FLOWER MOUND TX
75022-4839
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-8002
  • Fax:
Mailing address:
  • Phone: 972-899-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER GONYEAU
Title or Position: PRESIDENT
Credential: D.C.
Phone: 972-899-8002