MEDICARE: FIRST WELLNESS

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	8629	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0022JQ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1669666400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST WELLNESS

Provider Business Mailing Address
First Line	:	7739 NORTHCROSS DR
Second Line	:	SUITE J
City	:	AUSTIN
State	:	TX
Zip	:	78757-1700
Country	:	US
Telephone Number	:	512-451-9655
Fax Number	:	512-380-9599

Provider Business Practice Location Address
First Line	:	7739 NORTHCROSS DR
Second Line	:	SUITE J
City	:	AUSTIN
State	:	TX
Zip	:	78757-1700
Country	:	US
Telephone Number	:	512-451-9655
Fax Number	:	512-380-9599

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. JACK HUNTER OWEN
Credential	:	D.C.
Telephone Number	:	512-451-9655

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	02/27/2008

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Directions to “FIRST WELLNESS ” Practice Location

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