Provider Demographics
NPI:1235497728
Name:HEWITT NESSA & SAMUELIAN
Entity Type:Organization
Organization Name:HEWITT NESSA & SAMUELIAN
Other - Org Name:BACK TO BASICS HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-650-0736
Mailing Address - Street 1:20162 SW BIRCH ST STE 280
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1536
Mailing Address - Country:US
Mailing Address - Phone:949-650-0736
Mailing Address - Fax:
Practice Address - Street 1:20162 SW BIRCH ST STE 280
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1536
Practice Address - Country:US
Practice Address - Phone:949-650-0736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty