Provider Demographics
NPI:1417606849
Name:WAY OF WELLNESS HEALTHCARE INC.
Entity Type:Organization
Organization Name:WAY OF WELLNESS HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DAOM
Authorized Official - Phone:408-615-1995
Mailing Address - Street 1:4719 ATHERTON AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1002
Mailing Address - Country:US
Mailing Address - Phone:408-615-1995
Mailing Address - Fax:408-615-1999
Practice Address - Street 1:940 SARATOGA AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3409
Practice Address - Country:US
Practice Address - Phone:408-615-1995
Practice Address - Fax:408-615-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty