=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659063634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONGHORN INJURY AND WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2023
-----------------------------------------------------
Last Update Date | 05/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28765 INTERSTATE 10 W STE 106
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-9140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-755-4661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28765 INTERSTATE 10 W STE 106
-----------------------------------------------------
City | BOERNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78006-9140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANDREW WELSCH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 830-755-4661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------