Organization
FT. WORTH SPINAL DECOMPRESSION CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE WULLAERT (OWNER)
(817) 284-1235
Entity
Organization
Contact information
Practice address
1149 PRECINCT LINE RD STE A, HURST, TX 76053-4289
(817) 284-1235
(817) 284-1226
Mailing address
1149 PRECINCT LINE RD STE A, HURST, TX 76053-4289
(817) 284-1235
(817) 284-1226
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
6533
TX
Other
Enumeration date
11/08/2010
Last updated
11/08/2010
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