Healthcare Provider Details

I. General information

NPI: 1932459161
Provider Name (Legal Business Name): LYELL WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 W OLIVE AVE STE I
MERCED CA
95348-1900
US

IV. Provider business mailing address

1180 W OLIVE AVE STE I
MERCED CA
95348-1900
US

V. Phone/Fax

Practice location:
  • Phone: 209-384-3255
  • Fax: 209-384-1810
Mailing address:
  • Phone: 209-384-3255
  • Fax: 209-384-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC13566
License Number StateCA

VIII. Authorized Official

Name: DR. BRYANT OWENS
Title or Position: PRESIDENT/CEO
Credential: D.C.
Phone: 209-384-3255