=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588961726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSAL WELLNESS AND HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2011
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13817 HIGHWAY 59 SUITE C
-----------------------------------------------------
City | SPLENDORA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77372-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-303-9355
-----------------------------------------------------
Fax | 281-689-6351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13817 HIGHWAY 59 SUITE C
-----------------------------------------------------
City | SPLENDORA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77372-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-303-9355
-----------------------------------------------------
Fax | 281-689-6351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AMANDA GOLDEN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 614-795-7295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 11292
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------