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NPI Code Detail

MEDICARE: BONAFIDE WELLNESS, INC.

MEDICARE: BONAFIDE WELLNESS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor

General Provider Information

NPI Number : 1063362283
Entity Type Code : Organization
Provider Name (Legal Business Name) : BONAFIDE WELLNESS, INC.
Provider Business Mailing Address
First Line : 6330 SAN VICENTE BLVD STE 245
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-5425
Country : US
Telephone Number : 424-600-5010
Fax Number :
Provider Business Practice Location Address
First Line : 6330 SAN VICENTE BLVD STE 245
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-5425
Country : US
Telephone Number : 424-600-5010
Fax Number :
Authorized Official
Title or Position : CEO
Name : JAINEN SHIN
Credential : L.AC.
Telephone Number : 949-246-0811
Provider Enumeration Date : 01/28/2026
Last Update Date : 01/28/2026

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Directions to “BONAFIDE WELLNESS, INC. ” Practice Location

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