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General NPI Number Information
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NPI Number | 1639449812
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Entity Type | Organization
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Legal Business Name | SRB WELLNESS INC
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 5710 WATAUGA RD SUITE A
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City | WATAUGA
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State | TX
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Zip | 76148-3022
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Country | US
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Telephone | 817-281-0008
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Fax | 817-281-7333
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Provider Business Mailing Address
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Address Line | 5710 WATAUGA RD SUITE A
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City | WATAUGA
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State | TX
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Zip | 76148-3022
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Country | US
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Telephone | 817-281-0008
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Fax | 817-281-7333
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Authorized Official
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Title or Position | PRESIDENT / PROVIDER
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Name | DR. JEFFREY SCOTT RUTH
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Credential | D.C.
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Telephone | 817-281-0008
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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 | 8220
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License Number State | TX
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