Provider Demographics
NPI:1528829256
Name:IASOTO CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:IASOTO CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVYN
Authorized Official - Middle Name:DONIELLE
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSFN
Authorized Official - Phone:214-886-8576
Mailing Address - Street 1:1801 N HAMPTON RD STE 464
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2391
Mailing Address - Country:US
Mailing Address - Phone:469-454-8248
Mailing Address - Fax:
Practice Address - Street 1:1801 N HAMPTON RD STE 464
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2391
Practice Address - Country:US
Practice Address - Phone:469-454-8248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty