Organization
DIVINE MEDICAL WELLNESS CENTER INC
Active
Other names
Divine Medical Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL LYNN ROULUND DC (PRESIDENT)
(559) 222-5362
Entity
Organization
Contact information
Practice address
5150 N 6TH ST STE 100, FRESNO, CA 93710-7505
(559) 222-5362
Mailing address
5150 N 6TH ST STE 100, FRESNO, CA 93710-7505
(559) 222-5362
(559) 222-5028
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
208D00000X
General Practice Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
03/26/2014
Last updated
03/26/2014
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