Provider Demographics
NPI:1194126417
Name:380 CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:380 CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CACOZZA
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:214-901-7211
Mailing Address - Street 1:2414 W UNIVERSITY DR
Mailing Address - Street 2:112
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2853
Mailing Address - Country:US
Mailing Address - Phone:214-901-7211
Mailing Address - Fax:214-975-2666
Practice Address - Street 1:2414 W UNIVERSITY DR
Practice Address - Street 2:112
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-2853
Practice Address - Country:US
Practice Address - Phone:214-901-7211
Practice Address - Fax:214-975-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty