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General NPI Number Information
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NPI Number | 1962783258
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Entity Type | Organization
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Legal Business Name | ACTION HEALTHCARE & WELLNESS
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 210 N PARK BLVD SUITE 105
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City | GRAPEVINE
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State | TX
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Zip | 76051-6985
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Country | US
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Telephone | 817-812-3044
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Fax | 817-796-1378
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Provider Business Mailing Address
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Address Line | 210 N. PARK BLVD. SUITE 105
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City | GRAPEVINE
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State | TX
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Zip | 76051-6986
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Country | US
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Telephone | 817-812-3044
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Fax | 817-796-1378
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT DAVID LAUER
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Credential | DO
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Telephone | 817-812-3044
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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 | TX4202
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | K9102
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License Number State | TX
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