=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003239427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLNESS SOLUTIONS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2014
-----------------------------------------------------
Last Update Date | 01/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210. E CLARK AVENUE SUITE A
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-934-5761
-----------------------------------------------------
Fax | 805-937-1820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210. E CLARK AVENUE SUITE A
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-934-5761
-----------------------------------------------------
Fax | 805-937-1820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY LAYTON ANDERSON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 805-934-5761
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC17888
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------