NPIMap

Organization Active NPI

Back to Wellness Center

  • Chiropractor
  • Fort Worth, TX
National Provider Identifier
1376676957
Registry record updated Oct 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC8345 Issued in TX
Legal business name
BACK TO WELLNESS CENTER
Practice address
3930 W Vickery Blvd
Fort Worth, TX 76107-5626
Phone
(817) 732-3344
Fax
(817) 732-3353
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Beauford T. Erwin III, D.C.NPI 1215042171
Title
Owner
Phone
(817) 732-3344

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DC8345 TX Primary

Addresses

Primary practice location

3930 W Vickery Blvd
Fort Worth, TX 76107-5626

Mailing address

3930 W Vickery Blvd
Fort Worth, TX 76107-5626
Phone (817) 732-3344

Other identifiers 1

IdentifierTypeStateIssuer
0053KNOtherTXBCBS GROUP #

Other names 1

  • Injury Care Clinic Former legal business name

National Provider Directory

National Provider Directory

Locations

3930 W Vickery Blvd
Fort Worth, TX 76107
Phone (817) 732-3344

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223510400000",
    "number": "1376676957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 W VICKERY BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761075626",
            "telephone_number": "817-732-3344",
            "fax_number": "817-732-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 W VICKERY BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761075626",
            "telephone_number": "817-732-3344",
            "fax_number": "817-732-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2008-10-09",
        "status": "A",
        "authorized_official_last_name": "ERWIN",
        "authorized_official_first_name": "BEAUFORD",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-732-3344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "DC8345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "0053KN",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Injury Care Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.