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General NPI Number Information
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NPI Number | 1649654120
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Entity Type | Organization
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Legal Business Name | LAKEWOOD WELLNESS LLC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 6333 E MOCKINGBIRD LN STE 260
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City | DALLAS
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State | TX
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Zip | 75214-2368
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Country | US
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Telephone | 214-821-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 6333 E MOCKINGBIRD LN STE 260
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City | DALLAS
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State | TX
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Zip | 75214-2368
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Country | US
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Telephone | 214-821-2525
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Fax |
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | JESSICA RORIE
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Credential |
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Telephone | 214-821-2525
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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 | 12030
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License Number State | TX
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