Provider Demographics
NPI:1548446313
Name:GATEWAY TO WELLNESS CHIROPRACTIC,PLLC
Entity type:Organization
Organization Name:GATEWAY TO WELLNESS CHIROPRACTIC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GUYMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-250-2224
Mailing Address - Street 1:2051 CYPRESS CREEK RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3623
Mailing Address - Country:US
Mailing Address - Phone:512-250-2224
Mailing Address - Fax:
Practice Address - Street 1:2051 CYPRESS CREEK RD
Practice Address - Street 2:SUITE K
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3623
Practice Address - Country:US
Practice Address - Phone:512-250-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty