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General NPI Number Information
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NPI Number | 1912240623
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Entity Type | Organization
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Legal Business Name | 911 BIOCARE LLC
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 330 ALABAMA STREET SUITE D
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 855-901-0911
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Fax | 909-335-4886
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Provider Business Mailing Address
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Address Line | 330 ALABAMA STREET SUITE D
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 855-901-0911
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Fax | 909-335-4886
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Authorized Official
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Title or Position | OWNER
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Name | MR. WAYNE WOMACK
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Credential |
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Telephone | 855-901-0911
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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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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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