Provider Demographics
NPI:1093034969
Name:WELLNESS CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:WELLNESS CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-552-7033
Mailing Address - Street 1:4482 BARRANCA PKWY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7701
Mailing Address - Country:US
Mailing Address - Phone:949-552-7033
Mailing Address - Fax:949-552-7006
Practice Address - Street 1:4482 BARRANCA PKWY
Practice Address - Street 2:SUITE 190
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7701
Practice Address - Country:US
Practice Address - Phone:949-552-7033
Practice Address - Fax:949-552-7006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty