Provider Demographics
NPI:1144535063
Name:LOTUS WELLNESS CENTER LLC
Entity type:Organization
Organization Name:LOTUS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOSAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-315-3033
Mailing Address - Street 1:900 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1905
Mailing Address - Country:US
Mailing Address - Phone:714-637-6370
Mailing Address - Fax:
Practice Address - Street 1:900 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1905
Practice Address - Country:US
Practice Address - Phone:714-637-6370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11790171100000X
CAAC6915171100000X
CADC31690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty