Provider Demographics
NPI:1770206708
Name:PACIFIC WELLNESS CHIROPRACTIC
Entity type:Organization
Organization Name:PACIFIC WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-265-9925
Mailing Address - Street 1:PO BOX 90256
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92169-2256
Mailing Address - Country:US
Mailing Address - Phone:858-265-9925
Mailing Address - Fax:
Practice Address - Street 1:4645 CASS ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2846
Practice Address - Country:US
Practice Address - Phone:858-265-9925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty