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General NPI Number Information
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NPI Number | 1831509835
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Entity Type | Organization
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Legal Business Name | ADVANCED HEALTH AND WELLNESS CENTER OF PARMA
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 9687 BROOKPARK RD
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City | PARMA
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State | OH
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Zip | 44129-6811
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Country | US
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Telephone | 330-336-9500
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Fax | 330-336-3377
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Provider Business Mailing Address
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Address Line | 201 GREAT OAKS TRL
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City | WADSWORTH
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State | OH
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Zip | 44281-9430
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Country | US
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Telephone | 330-336-9500
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Fax | 330-336-3377
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDON BUPP
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Credential | D.C.
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Telephone | 330-336-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35064494
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License Number State | OH
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