Provider Demographics
NPI:1477734572
Name:MINDFUL CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:MINDFUL CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-799-9150
Mailing Address - Street 1:4772 KATELLA AVE
Mailing Address - Street 2:STE. # 102
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2681
Mailing Address - Country:US
Mailing Address - Phone:562-799-9150
Mailing Address - Fax:562-799-9130
Practice Address - Street 1:4772 KATELLA AVE
Practice Address - Street 2:STE. # 102
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2681
Practice Address - Country:US
Practice Address - Phone:562-799-9150
Practice Address - Fax:562-799-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30127111N00000X
CA30248111N00000X
111N00000X
CA11592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty