Healthcare Provider Details

I. General information

NPI: 1447876933
Provider Name (Legal Business Name): CHIROMAN WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N AVALON BLVD STE 6
WILMINGTON CA
90744-4547
US

IV. Provider business mailing address

802 N AVALON BLVD STE 6
WILMINGTON CA
90744-4547
US

V. Phone/Fax

Practice location:
  • Phone: 310-935-9348
  • Fax:
Mailing address:
  • Phone: 310-935-9348
  • 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: MS. VANESSA FERNANDEZ
Title or Position: MANAGER
Credential:
Phone: 310-755-0324