Provider Demographics
NPI:1396519831
Name:PROSPER WELLNESS LLC
Entity type:Organization
Organization Name:PROSPER WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAETTIG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DACM
Authorized Official - Phone:310-804-0009
Mailing Address - Street 1:1079 MEADOWBROOK AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6716
Mailing Address - Country:US
Mailing Address - Phone:310-804-0009
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 112
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5337
Practice Address - Country:US
Practice Address - Phone:310-804-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891473476OtherNPI
CA1730765512OtherNPI