Provider Demographics
NPI:1346422953
Name:WELLNESS CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:WELLNESS CHIROPRACTIC HEALTH CENTER
Other - Org Name:WELLNESS CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/WONER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSOFI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-535-2341
Mailing Address - Street 1:526 SOQUEL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2321
Mailing Address - Country:US
Mailing Address - Phone:831-535-2341
Mailing Address - Fax:209-835-5034
Practice Address - Street 1:526 SOQUEL AVE
Practice Address - Street 2:A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2321
Practice Address - Country:US
Practice Address - Phone:831-535-2341
Practice Address - Fax:209-835-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28765302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0287650Medicare PIN