Provider Demographics
NPI:1104563543
Name:TWIN WAVES WELLNESS CENTER
Entity type:Organization
Organization Name:TWIN WAVES WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNA
Authorized Official - Middle Name:KREEMER
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-487-8106
Mailing Address - Street 1:990 HIGHLAND DR STE 110Y
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-3403
Mailing Address - Country:US
Mailing Address - Phone:760-487-8106
Mailing Address - Fax:
Practice Address - Street 1:990 HIGHLAND DR STE 110Y
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-3403
Practice Address - Country:US
Practice Address - Phone:760-487-8106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty