MEDICARE: WELLNESS CHIROPRACTIC HEALTH CENTER

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
1	302F00000X	Exclusive Provider Organization	DC28765	CA

General Provider Information

NPI Number	:	1346422953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS CHIROPRACTIC HEALTH CENTER

Provider Business Mailing Address
First Line	:	526 SOQUEL AVE
Second Line	:	SUITE A
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2321
Country	:	US
Telephone Number	:	831-535-2341
Fax Number	:	209-835-5034

Provider Business Practice Location Address
First Line	:	526 SOQUEL AVE
Second Line	:	A
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2321
Country	:	US
Telephone Number	:	831-535-2341
Fax Number	:	209-835-5034

Authorized Official
Title or Position	:	DOCTOR/WONER
Name	:	DR. LINA YOUSOFI
Credential	:	D.C.
Telephone Number	:	831-535-2341

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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