MEDICARE: WELLNESS VIDA CENTER LLC

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	111N00000X	Chiropractor	12677	TX

General Provider Information

NPI Number	:	1154737385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS VIDA CENTER LLC

Provider Business Mailing Address
First Line	:	12800 PRESTON RD STE 102
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12800 PRESTON RD STE 102
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1366
Country	:	US
Telephone Number	:	469-677-0029
Fax Number	:	214-792-9697

Authorized Official
Title or Position	:	OWNER
Name	:	EVELIA ARAGON
Credential	:	DC
Telephone Number	:	214-783-3231

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	01/15/2021

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Directions to “WELLNESS VIDA CENTER LLC ” Practice Location

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