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General NPI Number Information
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NPI Number | 1376970202
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Entity Type | Organization
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Legal Business Name | TEXARKANA HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 1718 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-2415
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Country | US
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Telephone | 903-838-5883
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Fax | 903-223-9075
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Provider Business Mailing Address
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Address Line | 1718 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-2415
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Country | US
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Telephone | 903-838-5883
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Fax | 903-223-9075
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MS. MIA ADAMS MCDOUGAL
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Credential | DC
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Telephone | 903-838-5883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 11844
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License Number State | TX
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