# DIVINE MEDICAL WELLNESS CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Divine Medical Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972920098
- **Authorized official:** DR. RANDALL LYNN ROULUND DC (PRESIDENT)
- **Authorized official phone:** (559) 222-5362

## Contact information

- **Practice address:** 5150 N 6TH ST STE 100, FRESNO, CA 93710-7505
- **Practice address phone:** (559) 222-5362
- **Mailing address:** 5150 N 6TH ST STE 100, FRESNO, CA 93710-7505
- **Mailing address phone:** (559) 222-5362
- **Mailing address fax:** (559) 222-5028

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/26/2014
- **Last updated:** 03/26/2014