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General NPI Number Information
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NPI Number | 1225491426
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Entity Type | Organization
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Legal Business Name | ASPIRE INTEGRATIVE HEALTH CLINIC
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 2202 GATEWAY DR STE D
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City | OPELIKA
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State | AL
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Zip | 36801-6870
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Country | US
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Telephone | 334-203-1723
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Fax |
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Provider Business Mailing Address
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Address Line | 2202 GATEWAY DR STE D
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City | OPELIKA
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State | AL
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Zip | 36801-6870
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Country | US
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Telephone | 334-203-1723
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIENGXAY MALAVONG
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Credential | DO
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Telephone | 334-203-1723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | DO. 1492
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License Number State | AL
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