Provider Demographics
NPI:1760680979
Name:WELLNESS CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:WELLNESS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSOFI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-830-1799
Mailing Address - Street 1:227 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4015
Mailing Address - Country:US
Mailing Address - Phone:209-830-1799
Mailing Address - Fax:209-835-5034
Practice Address - Street 1:227 E 11TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4015
Practice Address - Country:US
Practice Address - Phone:209-830-1799
Practice Address - Fax:209-835-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0287650Medicare PIN
CAU95977Medicare UPIN