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General NPI Number Information
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NPI Number | 1528829256
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Entity Type | Organization
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Legal Business Name | IASOTO CHIROPRACTIC WELLNESS CENTER
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 1801 N HAMPTON RD STE 464
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City | DESOTO
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State | TX
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Zip | 75115-2391
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Country | US
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Telephone | 469-454-8248
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 N HAMPTON RD STE 464
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City | DESOTO
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State | TX
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Zip | 75115-2391
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Country | US
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Telephone | 469-454-8248
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC/ OWNER
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Name | RAVYN DONIELLE COTTON
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Credential | DC, MSFN
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Telephone | 214-886-8576
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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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