MEDICARE: THE WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00964	TX

General Provider Information

NPI Number	:	1073797569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2481 FOREST PARK BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2481 FOREST PARK BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1731
Country	:	US
Telephone Number	:	817-926-9642
Fax Number	:

Authorized Official
Title or Position	:	L.AC
Name	:	MING LAI
Credential	:
Telephone Number	:	817-926-9642

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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Directions to “THE WELLNESS CENTER ” Practice Location

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