=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619004538
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS ALPHA WELLNESS CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 09/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1340 S MAIN STREET SUITE 305
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-7509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-251-9828
-----------------------------------------------------
Fax | 817-251-9829
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1340 S MAIN STREET SUITE 305
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051-7509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-251-9828
-----------------------------------------------------
Fax | 817-251-9829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER CHIROPRACTOR
-----------------------------------------------------
Name | DR. JANELLE D WHITEHEAD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 817-251-9828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 10893
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------