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General NPI Number Information
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NPI Number | 1174647457
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Entity Type | Organization
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Legal Business Name | BACK-2-WELLNESS PA
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 2397 NW MILITARY HWY SUITE D
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City | SAN ANTONIO
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State | TX
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Zip | 78231-2527
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Country | US
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Telephone | 210-342-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 2397 NW MILITARY HWY SUITE D
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City | SAN ANTONIO
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State | TX
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Zip | 78231-2527
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Country | US
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Telephone | 210-342-3507
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES WALTER BRAMBLETT II
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Credential | D.C.
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Telephone | 210-342-3507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9597
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License Number State | TX
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