MEDICARE: MIND & BODY HEALTH SOLUTIONS 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	10856	TX
2	208D00000X	General Practice Physician
3	208D00000X	General Practice Physician	L3329	TX

General Provider Information

NPI Number	:	1639450018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND & BODY HEALTH SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	PO BOX 487
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76004-0487
Country	:	US
Telephone Number	:	682-521-5700
Fax Number	:	817-460-1220

Provider Business Practice Location Address
First Line	:	2233 AVENUE J STE 101
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-5884
Country	:	US
Telephone Number	:	817-460-7080
Fax Number	:	817-460-1220

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. GERMAINE BERNARD HAWKINS
Credential	:	DO
Telephone Number	:	682-521-5700

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	01/07/2019

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