Provider Demographics
NPI:1952677247
Name:LATITUDE 34 WELLNESS
Entity Type:Organization
Organization Name:LATITUDE 34 WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-652-0085
Mailing Address - Street 1:369 S DOHENY DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3577
Mailing Address - Country:US
Mailing Address - Phone:310-652-0085
Mailing Address - Fax:310-652-1002
Practice Address - Street 1:8500 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1006
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3121
Practice Address - Country:US
Practice Address - Phone:310-652-0085
Practice Address - Fax:310-652-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty