Provider Demographics
NPI:1124883186
Name:WRINKLE, NATASHA NICOLE (DC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:WRINKLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SARRA LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-7602
Mailing Address - Country:US
Mailing Address - Phone:817-565-6307
Mailing Address - Fax:
Practice Address - Street 1:8401 ANDERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-3857
Practice Address - Country:US
Practice Address - Phone:817-609-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor