Healthcare Provider Details

I. General information

NPI: 1972152049
Provider Name (Legal Business Name): DAO OF WELLNESS INTEGRATIVE MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 LYNDALE AVE S
MINNEAPOLIS MN
55408-2171
US

IV. Provider business mailing address

597 VIKING DR E
LITTLE CANADA MN
55117-1662
US

V. Phone/Fax

Practice location:
  • Phone: 612-314-3321
  • Fax:
Mailing address:
  • Phone: 612-314-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN R THOMPSON
Title or Position: OWNER/CEO
Credential: DACM, DC, L.AC.
Phone: 612-314-3321