Provider Demographics
NPI:1912704974
Name:THERAPEUO WELLNESS CENTER
Entity type:Organization
Organization Name:THERAPEUO WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:NGOMA
Authorized Official - Last Name:KABWE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-297-1183
Mailing Address - Street 1:9312 SHOVELER TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7778
Mailing Address - Country:US
Mailing Address - Phone:469-297-1183
Mailing Address - Fax:
Practice Address - Street 1:1228 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4290
Practice Address - Country:US
Practice Address - Phone:817-282-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty