MEDICARE: DR. IRENE WABOMNOR DC

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
2	111N00000X	Chiropractor	13097	TX

General Provider Information

NPI Number	:	1144848391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENE WABOMNOR DC

Provider Business Mailing Address
First Line	:	505 E LAMAR BLVD STE 426
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-3945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 E LAMAR BLVD STE 426
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-3945
Country	:	US
Telephone Number	:	708-408-4962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	06/17/2026

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