=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205281599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BE WELL WESTERN CAROLINA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2016
-----------------------------------------------------
Last Update Date | 04/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 FORGA PLAZA LOOP
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28786-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-734-7702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 FORGA PLAZA LOOP
-----------------------------------------------------
City | WAYNESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28786-1932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-734-7702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR OT NATUROPATHY
-----------------------------------------------------
Name | MICHELLE L SANDERBECK
-----------------------------------------------------
Credential | ND
-----------------------------------------------------
Telephone | 828-734-7702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------