Provider Demographics
NPI:1205523859
Name:HEALTH AND WELLNESS OF TEXAS
Entity type:Organization
Organization Name:HEALTH AND WELLNESS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRIMARY CARE
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:NMD, LAC
Authorized Official - Phone:682-704-7842
Mailing Address - Street 1:17480 DALLAS PKWY STE 212
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7362
Mailing Address - Country:US
Mailing Address - Phone:469-617-8229
Mailing Address - Fax:915-201-1658
Practice Address - Street 1:17480 DALLAS PKWY STE 212
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7362
Practice Address - Country:US
Practice Address - Phone:469-617-8229
Practice Address - Fax:915-201-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty