=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114104536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A CENTER FOR WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2008
-----------------------------------------------------
Last Update Date | 01/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8222 MELROSE AVE SUITE 300
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90046-6825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-653-4826
-----------------------------------------------------
Fax | 323-653-0216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8222 MELROSE AVE SUITE 300
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90046-6825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-653-4826
-----------------------------------------------------
Fax | 323-653-0216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARRY L KAYE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 323-653-4826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC17298
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------