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General NPI Number Information
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NPI Number | 1548556624
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Entity Type | Organization
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Legal Business Name | 180 WELLNESS, LLP
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 321 W SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6188
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Country | US
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Telephone | 817-337-5199
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Fax |
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Provider Business Mailing Address
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Address Line | 321 W. SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6188
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Country | US
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Telephone | 817-337-5199
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | MR. DAVID WADE PARKHILL
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Credential | D.C.
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Telephone | 817-337-5199
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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 | 6927
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6741
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License Number State | TX
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