=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417187949
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHOLELIFE CHIROPRACTIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2009
-----------------------------------------------------
Last Update Date | 08/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8521 N 10TH ST
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-9536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-686-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8521 N 10TH ST
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-9536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-686-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ORLANDO N. VILLARREAL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 956-686-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NP0017X
-----------------------------------------------------
Taxonomy Name | Pediatric Chiropractor
-----------------------------------------------------
License Number | 10680
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------