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General NPI Number Information
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NPI Number | 1023334414
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Entity Type | Organization
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Legal Business Name | PROWELLNESS
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 350 RESERVATION RD
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City | MARINA
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State | CA
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Zip | 93933-3264
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Country | US
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Telephone | 831-359-4239
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Fax | 831-582-9753
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Provider Business Mailing Address
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Address Line | 350 RESERVATION RD
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City | MARINA
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State | CA
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Zip | 93933-3264
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Country | US
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Telephone | 831-359-4239
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Fax | 831-582-9753
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Authorized Official
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Title or Position | OWNER
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Name | JOOHWAN KO
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Credential | D.C.
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Telephone | 831-359-4239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 26213
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License Number State | CA
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