Healthcare Provider Details

I. General information

NPI: 1013328517
Provider Name (Legal Business Name): BENEVIDA HEALTH AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 EVERETT DR SUITE 200
KYLE TX
78640-6146
US

IV. Provider business mailing address

4100 EVERETT DR SUITE 200
KYLE TX
78640-6146
US

V. Phone/Fax

Practice location:
  • Phone: 512-268-2768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11596
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JEANNE LAIN
Title or Position: OWNER
Credential:
Phone: 512-268-2768