MEDICARE: TERRELL CHIROPRACTIC AND WELLNESS CENTER, INC

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	261Q00000X	Clinic/Center
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1982187381	OTHER	TX	PERSONAL NPI

General Provider Information

NPI Number	:	1841765773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRELL CHIROPRACTIC AND WELLNESS CENTER, INC

Provider Business Mailing Address
First Line	:	1409 W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-2303
Country	:	US
Telephone Number	:	972-563-1557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-2303
Country	:	US
Telephone Number	:	972-563-1557
Fax Number	:

Authorized Official
Title or Position	:	CIROPRACTOR/OWNER
Name	:	DR. CORINA MCCLARY WILD
Credential	:	DC
Telephone Number	:	214-789-0549

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	10/08/2018

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