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General NPI Number Information
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NPI Number | 1386830925
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC WELLNESS GROUP
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 969 E GREEN ST
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City | PASADENA
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State | CA
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Zip | 91106-2410
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Country | US
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Telephone | 626-584-9355
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Fax | 626-584-9577
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Provider Business Mailing Address
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Address Line | 969 E GREEN ST
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City | PASADENA
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State | CA
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Zip | 91106-2410
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Country | US
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Telephone | 626-584-9355
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Fax | 626-584-9577
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEXTER A. WILLIAMS
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Credential | D.C.
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Telephone | 626-584-9355
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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 | DC17409
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License Number State | CA
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