Healthcare Provider Details

I. General information

NPI: 1841765773
Provider Name (Legal Business Name): TERRELL CHIROPRACTIC AND WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 W MOORE AVE
TERRELL TX
75160-2303
US

IV. Provider business mailing address

1409 W MOORE AVE
TERRELL TX
75160-2303
US

V. Phone/Fax

Practice location:
  • Phone: 972-563-1557
  • Fax:
Mailing address:
  • Phone: 972-563-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CORINA MCCLARY WILD
Title or Position: CIROPRACTOR/OWNER
Credential: DC
Phone: 214-789-0549