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General NPI Number Information
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NPI Number | 1508246257
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Entity Type | Organization
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Legal Business Name | PHOENIX WELLNESS AND NUTRITION PLLC
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 4706 FLEMING DOWNE LN
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City | SPRING
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State | TX
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Zip | 77388-3829
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Country | US
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Telephone | 832-914-7368
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Fax | 832-717-7621
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Provider Business Mailing Address
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Address Line | 33300 EGYPT LN STE. I-20
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City | MAGNOLIA
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State | TX
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Zip | 77354-2739
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Country | US
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Telephone | 832-914-7368
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Fax | 832-717-7621
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LYNNETTE ORRICK
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Credential | DC
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Telephone | 832-914-7368
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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 |
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License Number State |
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