=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649602947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLATINUM WELLNESS CENTERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2013
-----------------------------------------------------
Last Update Date | 08/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4311 OAK LAWN AVE SUITE 370
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75219-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-295-4237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4311 OAK LAWN AVE SUITE 370
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75219-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-295-4237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. CHRISTOPHER WAYNE CURRY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 214-295-4237
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 12371
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------