Healthcare Provider Details

I. General information

NPI: 1912155151
Provider Name (Legal Business Name): CENTER FOR HEALING AND WHOLENESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N WASHINGTON ST
GRAND FORKS ND
58203-3450
US

IV. Provider business mailing address

117 N WASHINGTON ST
GRAND FORKS ND
58203-3450
US

V. Phone/Fax

Practice location:
  • Phone: 701-738-8888
  • Fax:
Mailing address:
  • Phone: 701-738-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberR25276
License Number StateND

VIII. Authorized Official

Name: MR. DAVID C MAGNUSON
Title or Position: ACUPUNCTURIST
Credential: DIPL. AC.
Phone: 701-738-8888