Provider Demographics
NPI:1528561297
Name:THE HEALING WELLNESS CENTER
Entity Type:Organization
Organization Name:THE HEALING WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-394-0288
Mailing Address - Street 1:1101 S WINCHESTER BLVD STE D138
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3914
Mailing Address - Country:US
Mailing Address - Phone:408-394-0288
Mailing Address - Fax:408-217-8327
Practice Address - Street 1:1101 S WINCHESTER BLVD STE D138
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-394-0288
Practice Address - Fax:408-217-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
CAAC15197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18474OtherCHIROPRACTOR
CADC34197OtherCHIROPRACTOR
CAAC17988OtherACUPUNCTURIST
CADC34250OtherCHIROPRACTIC
CAPT19358OtherPHYSICAL THERAPIST
CAAC15197OtherACUPUNCTURIST
CAAC17520OtherACUPUNCTURIST
CAAC14135OtherACUPUNCTURIST
CADC34230OtherCHIROPRACTOR
CAAC18698OtherACUPUNCTURIST
CADC34290OtherCHIROPRACTOR