Healthcare Provider Details

I. General information

NPI: 1912240623
Provider Name (Legal Business Name): 911 BIOCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ALABAMA STREET SUITE D
REDLANDS CA
92373
US

IV. Provider business mailing address

330 ALABAMA STREET SUITE D
REDLANDS CA
92373
US

V. Phone/Fax

Practice location:
  • Phone: 855-901-0911
  • Fax: 909-335-4886
Mailing address:
  • Phone: 855-901-0911
  • Fax: 909-335-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WAYNE WOMACK
Title or Position: OWNER
Credential:
Phone: 855-901-0911