Healthcare Provider Details

I. General information

NPI: 1972073377
Provider Name (Legal Business Name): WOOD RIVER ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 ADDISON AVE EAST
TWIN FALLS ID
83301
US

IV. Provider business mailing address

1625 ADDISON AVE EAST
TWIN FALLS ID
83301
US

V. Phone/Fax

Practice location:
  • Phone: 208-735-1429
  • Fax: 208-735-9030
Mailing address:
  • Phone: 208-735-1429
  • Fax: 208-735-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JON P MORSE
Title or Position: OWNER
Credential: L. AC.
Phone: 208-735-1429