Healthcare Provider Details

I. General information

NPI: 1629398037
Provider Name (Legal Business Name): HEATHER MICHELLE WHEELER L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OFALLON COMMONS DR
O FALLON MO
63368-7931
US

IV. Provider business mailing address

2011 WILLIAMSTOWN DR
SAINT PETERS MO
63376-8109
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-0970
  • Fax: 636-978-7570
Mailing address:
  • Phone: 618-580-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2010008294
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: