Healthcare Provider Details

I. General information

NPI: 1588960637
Provider Name (Legal Business Name): 180 CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11161 SUMAC RD
GILMER TX
75644-5886
US

IV. Provider business mailing address

11161 SUMAC RD
GILMER TX
75644-5886
US

V. Phone/Fax

Practice location:
  • Phone: 903-918-4507
  • Fax:
Mailing address:
  • Phone: 903-918-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBIN LEIGH STEPHENSON
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 903-918-4507