Healthcare Provider Details

I. General information

NPI: 1063330975
Provider Name (Legal Business Name): THE POWERFUL BODY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 STATE HIGHWAY 114 SUITE 400
TROPHY CLUB TX
76262
US

IV. Provider business mailing address

5101 SQUAW CREEK CT
FORT WORTH TX
76137-3531
US

V. Phone/Fax

Practice location:
  • Phone: 817-859-2639
  • Fax: 817-438-0952
Mailing address:
  • Phone: 702-738-5374
  • Fax: 817-438-0952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MANUEL ALESSIO TREVINO
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 702-738-5374