Healthcare Provider Details

I. General information

NPI: 1235308214
Provider Name (Legal Business Name): MEGGAN L BAUMGARTNER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 S JEFFERSON ST STE. 3
MOSCOW ID
83843-3096
US

IV. Provider business mailing address

PO BOX 9381
MOSCOW ID
83843-0118
US

V. Phone/Fax

Practice location:
  • Phone: 208-669-2287
  • Fax: 208-882-5710
Mailing address:
  • Phone: 208-669-2287
  • Fax: 208-882-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU-213
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: