=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629962873
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | Q&C WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2025
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1734 N MAYS ST
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78664-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-347-7519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 572 BLUE AGAVE LN
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78626-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-347-7519
-----------------------------------------------------
Fax | 325-347-7519
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYEE
-----------------------------------------------------
Name | CHRISTOPHER DEMAREE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 325-347-7519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------