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General NPI Number Information
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NPI Number | 1275881906
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Entity Type | Organization
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Legal Business Name | BODY WISDOM CENTER FOR HEALING, INC.
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 23232 PERALTA DR SUITE 205
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1437
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Country | US
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Telephone | 949-458-6728
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Fax | 949-458-6729
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Provider Business Mailing Address
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Address Line | 23232 PERALTA DR SUITE 205
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1437
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Country | US
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Telephone | 949-458-6728
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Fax | 949-458-6729
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAY H GIN
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Credential | D.C.
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Telephone | 949-458-6728
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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 | 26053
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License Number State | CA
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