Healthcare Provider Details

I. General information

NPI: 1093974875
Provider Name (Legal Business Name): DOREEN V GILES DIPL. AC., C.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 WINNEBAGO ST
MADISON WI
53704-5370
US

IV. Provider business mailing address

2037 WINNEBAGO ST
MADISON WI
53704-5370
US

V. Phone/Fax

Practice location:
  • Phone: 608-244-2446
  • Fax:
Mailing address:
  • Phone: 608-244-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number158-055
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: