Provider Demographics
NPI:1932459161
Name:LYELL WELLNESS, INC
Entity Type:Organization
Organization Name:LYELL WELLNESS, INC
Other - Org Name:MERCED CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-384-3255
Mailing Address - Street 1:1180 W OLIVE AVE STE I
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1900
Mailing Address - Country:US
Mailing Address - Phone:209-384-3255
Mailing Address - Fax:209-384-1810
Practice Address - Street 1:1180 W OLIVE AVE STE I
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1900
Practice Address - Country:US
Practice Address - Phone:209-384-3255
Practice Address - Fax:209-384-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518058337Medicare UPIN
CAFB084ZMedicare PIN