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General NPI Number Information
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NPI Number | 1861686339
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Entity Type | Organization
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Legal Business Name | 360 CHIROPRACTIC & WELLNESS PLLC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 8837 LEBANON RD SUITE 200
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City | FRISCO
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State | TX
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Zip | 75034-8659
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Country | US
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Telephone | 469-474-6133
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Fax | 214-618-8089
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Provider Business Mailing Address
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Address Line | 8837 LEBANON RD SUITE 200
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City | FRISCO
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State | TX
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Zip | 75034-8659
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Country | US
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Telephone | 469-474-6133
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Fax | 214-618-8089
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Authorized Official
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Title or Position | MEMBER - LLC
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Name | DR. MATTHEW PHILIP THOMAS
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Credential | D.C.
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Telephone | 469-474-6133
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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 | 10435
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License Number State | TX
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