Healthcare Provider Details

I. General information

NPI: 1639880149
Provider Name (Legal Business Name): WELLSPRING INTEGRATIVE HEALTH & ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PETALUMA AVE STE 2E
SEBASTOPOL CA
95472-4234
US

IV. Provider business mailing address

101 ORETSKY WAY
COTATI CA
94931-5327
US

V. Phone/Fax

Practice location:
  • Phone: 707-492-5356
  • Fax: 707-492-5349
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES FIALK
Title or Position: PRESIDENT, CEO
Credential: L.AC, ND
Phone: 707-492-5356