Healthcare Provider Details

I. General information

NPI: 1477075711
Provider Name (Legal Business Name): 5 ELEMENTS NATURL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6635 FLANDERS DR STE G
SAN DIEGO CA
92121-2978
US

IV. Provider business mailing address

6635 FLANDERS DR STE G
SAN DIEGO CA
92121-2978
US

V. Phone/Fax

Practice location:
  • Phone: 858-564-8236
  • Fax:
Mailing address:
  • Phone: 858-564-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33044
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL D SCOTT
Title or Position: DIRECTOR
Credential: DC
Phone: 858-564-8236