Provider Demographics
NPI:1447494067
Name:FOUNDATIONAL WELLNESS, PC
Entity type:Organization
Organization Name:FOUNDATIONAL WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZWIERSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-469-1858
Mailing Address - Street 1:6700 MAIN ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-1646
Mailing Address - Country:US
Mailing Address - Phone:214-469-1858
Mailing Address - Fax:214-469-2461
Practice Address - Street 1:6700 MAIN ST
Practice Address - Street 2:SUITE 116
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-1646
Practice Address - Country:US
Practice Address - Phone:214-469-1858
Practice Address - Fax:214-469-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty