Provider Demographics
NPI:1972750719
Name:VILLAGE CHIROPRACTIC AND WELLNESS P.L.L.C.
Entity type:Organization
Organization Name:VILLAGE CHIROPRACTIC AND WELLNESS P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PULIDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-538-0878
Mailing Address - Street 1:3023 MARINA BAY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2882
Mailing Address - Country:US
Mailing Address - Phone:281-538-0878
Mailing Address - Fax:281-535-3550
Practice Address - Street 1:3023 MARINA BAY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2882
Practice Address - Country:US
Practice Address - Phone:281-538-0878
Practice Address - Fax:281-535-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090NAOtherBLUE CROSS /BLUE SHIELD
TX0090NAOtherBLUE CROSS /BLUE SHIELD