Provider Demographics
NPI:1144858499
Name:STR8 UP WELLNESS
Entity type:Organization
Organization Name:STR8 UP WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-656-1265
Mailing Address - Street 1:333 E BETHANY DR # K130
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3801
Mailing Address - Country:US
Mailing Address - Phone:469-656-1265
Mailing Address - Fax:
Practice Address - Street 1:333 E BETHANY DR # K130
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3801
Practice Address - Country:US
Practice Address - Phone:469-656-1265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty