Organization
JERIKA PA
Active
Other names
Body Tune-Up
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA STANGENWALD WILSON DC (PRESIDENT)
(817) 281-9040
Entity
Organization
Contact information
Practice address
466 MID CITIES BLVD, HURST, TX 76054-2430
(817) 281-9040
(817) 281-4249
Mailing address
466 MID CITIES BLVD, HURST, TX 76054-2430
(817) 281-9040
(817) 281-4249
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
10088
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00704Z
MEDICARE, GROUP BILLING N
TX
Enumeration date
07/20/2007
Last updated
07/20/2007
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