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General NPI Number Information
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NPI Number | 1679673719
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Entity Type | Organization
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Legal Business Name | SAN JOAQUIN WELLNESS & MEDICAL GROUP, INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 1201 24TH ST B-200
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City | BAKERSFIELD
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State | CA
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Zip | 93301-2310
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Country | US
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Telephone | 661-324-4431
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Fax | 661-324-5616
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Provider Business Mailing Address
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Address Line | 1201 24TH ST B-200
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City | BAKERSFIELD
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State | CA
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Zip | 93301-2310
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Country | US
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Telephone | 661-324-4431
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Fax | 661-324-5616
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. VINCENT STEVEN BOOTH
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Credential | D.C.
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Telephone | 661-324-4431
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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 | DC0143200
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A89666
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License Number State | CA
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