Healthcare Provider Details

I. General information

NPI: 1336418094
Provider Name (Legal Business Name): CHIRO ONE WELLNESS CENTER OF IRVING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E JOHN CARPENTER FWY SUITE 150
IRVING TX
75062-3569
US

IV. Provider business mailing address

PO BOX 677632
DALLAS TX
75267-7632
US

V. Phone/Fax

Practice location:
  • Phone: 972-573-6820
  • Fax: 972-573-6821
Mailing address:
  • Phone: 630-320-6400
  • Fax: 630-320-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAM WANG
Title or Position: COO
Credential:
Phone: 630-468-1824