Provider Demographics
NPI:1871754960
Name:WELLNESS PAIN CENTER, LLC
Entity type:Organization
Organization Name:WELLNESS PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-317-4666
Mailing Address - Street 1:PO BOX 678538
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8538
Mailing Address - Country:US
Mailing Address - Phone:214-317-4666
Mailing Address - Fax:214-317-4667
Practice Address - Street 1:3060 COMMUNICATIONS PKWY
Practice Address - Street 2:ST 104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8449
Practice Address - Country:US
Practice Address - Phone:214-317-4666
Practice Address - Fax:214-317-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain