Healthcare Provider Details

I. General information

NPI: 1497317762
Provider Name (Legal Business Name): ELEMENTS OF WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2019
Last Update Date: 07/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 CAHUENGA BLVD W STE 206
LOS ANGELES CA
90068-1359
US

IV. Provider business mailing address

3535 CAHUENGA BLVD W STE 206
LOS ANGELES CA
90068-1359
US

V. Phone/Fax

Practice location:
  • Phone: 323-600-4303
  • Fax:
Mailing address:
  • Phone: 323-600-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHETT MALLETT
Title or Position: SECRETARY
Credential: D.C.
Phone: 323-600-4303