Provider Demographics
NPI:1295281103
Name:STORMS WELLNESS CENTER
Entity type:Organization
Organization Name:STORMS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:STORMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-945-7890
Mailing Address - Street 1:1800 OAK PARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4479
Mailing Address - Country:US
Mailing Address - Phone:925-945-7890
Mailing Address - Fax:925-945-8691
Practice Address - Street 1:1800 OAK PARK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4479
Practice Address - Country:US
Practice Address - Phone:925-945-7890
Practice Address - Fax:925-945-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ23453174V00000X
CA58058225700000X
CA989463225700000X
CA581938225700000X
CAAC16493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174V00000XOther Service ProvidersClinical EthicistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty