Healthcare Provider Details

I. General information

NPI: 1639449812
Provider Name (Legal Business Name): SRB WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 WATAUGA RD SUITE A
WATAUGA TX
76148-3022
US

IV. Provider business mailing address

5710 WATAUGA RD SUITE A
WATAUGA TX
76148-3022
US

V. Phone/Fax

Practice location:
  • Phone: 817-281-0008
  • Fax: 817-281-7333
Mailing address:
  • Phone: 817-281-0008
  • Fax: 817-281-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8220
License Number StateTX

VIII. Authorized Official

Name: DR. JEFFREY SCOTT RUTH
Title or Position: PRESIDENT / PROVIDER
Credential: D.C.
Phone: 817-281-0008