Healthcare Provider Details

I. General information

NPI: 1669742490
Provider Name (Legal Business Name): CHRISTOPHER DOUGLAS LANDOLL LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N SALEM ST STE 204B
APEX NC
27502-1461
US

IV. Provider business mailing address

104 LANEWOOD WAY
APEX NC
27502-3938
US

V. Phone/Fax

Practice location:
  • Phone: 919-335-5422
  • Fax:
Mailing address:
  • Phone: 206-972-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number975
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: