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General NPI Number Information
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NPI Number | 1538550025
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Entity Type | Organization
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Legal Business Name | ACTIVE CHIROPRACTIC AND WELLNESS
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 923 W JEFFERSON BLVD
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City | DALLAS
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State | TX
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Zip | 75208-5050
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Country | US
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Telephone | 214-380-9219
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Fax |
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Provider Business Mailing Address
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Address Line | 923 W JEFFERSON BLVD
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City | DALLAS
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State | TX
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Zip | 75208-5050
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Country | US
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Telephone | 214-380-9219
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL ALEJANDRO CUELLAR
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Credential |
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Telephone | 214-909-7560
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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 | 10432
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License Number State | TX
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