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General NPI Number Information
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NPI Number | 1508718677
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Entity Type | Organization
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Legal Business Name | GENERATIONAL HEALTH COLLECTIVE, LLC
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 2301 S BROADWAY AVE STE B10
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City | TYLER
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State | TX
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Zip | 75701-5409
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Country | US
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Telephone | 903-573-0461
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Fax |
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Provider Business Mailing Address
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Address Line | 5924 PINE CONE LN
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City | TYLER
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State | TX
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Zip | 75707-6289
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Country | US
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Telephone | 903-573-0461
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MATTHEW R BYNUM
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Credential | DC
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Telephone | 903-573-0461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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