| Organization Name: | RENAISSANCE HEALTH AND WELLNESS OF TEXAS, P.A. |
| NPI Number: | 1881082238 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHESTER L CARLSON (MEDICAL DIRECTOR) |
| Mailing Address: | 17721 Dallas Pkwy Suite 116 Dallas |
| State: | TX US |
| Postal Code: | 752877343 |
| Phone Number: | 2143784700 |
| Fax Number: | |
| NPI Enumeration Date: | 01/07/2015 |
| NPI Last Update Date: | 01/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | Q2522 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |