Provider Demographics
NPI:1407040140
Name:C & C WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:C & C WELLNESS CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HSIAO-LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:817-583-8808
Mailing Address - Street 1:8305 WHITLEY RD
Mailing Address - Street 2:STE A
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2483
Mailing Address - Country:US
Mailing Address - Phone:817-583-8808
Mailing Address - Fax:817-583-8808
Practice Address - Street 1:8305 WHITLEY RD
Practice Address - Street 2:STE A
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2483
Practice Address - Country:US
Practice Address - Phone:817-583-8808
Practice Address - Fax:817-583-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066QAOtherBCBS OF TX