Healthcare Provider Details

I. General information

NPI: 1063089423
Provider Name (Legal Business Name): ATTIVO WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5042 WILSHIRE BLVD STE 222
LOS ANGELES CA
90036-4305
US

IV. Provider business mailing address

1550 W HORIZON RIDGE PKWY STE R612
HENDERSON NV
89012-3600
US

V. Phone/Fax

Practice location:
  • Phone: 310-212-7006
  • Fax:
Mailing address:
  • Phone: 310-212-7006
  • Fax: 310-212-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: EDWARD CUNNINGHAM
Title or Position: OWNER, DC
Credential:
Phone: 310-212-7006