Healthcare Provider Details

I. General information

NPI: 1043758014
Provider Name (Legal Business Name): INNER QI WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 RIMPAU AVE STE 106
CORONA CA
92879-5724
US

IV. Provider business mailing address

710 RIMPAU AVE STE 106
CORONA CA
92879-5724
US

V. Phone/Fax

Practice location:
  • Phone: 951-428-4135
  • Fax: 951-339-3623
Mailing address:
  • Phone: 951-428-4135
  • Fax: 951-339-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC32763
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15255
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15916
License Number StateCA

VIII. Authorized Official

Name: DR. THALES SAIKI RUELA
Title or Position: PRESIDENT/ACUPUNCTURIST
Credential: L.AC.
Phone: 951-428-4135