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General NPI Number Information
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NPI Number | 1720469844
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Entity Type | Organization
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Legal Business Name | BACK TO WELLNESS INC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 3800 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90063-1805
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Country | US
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Telephone | 323-264-6296
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Fax | 323-264-6297
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Provider Business Mailing Address
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Address Line | 3800 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90063-1805
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Country | US
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Telephone | 323-264-6296
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Fax | 323-264-6297
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSANA ARROYO
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Credential | DC
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Telephone | 323-264-6296
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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 |
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License Number State |
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