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General NPI Number Information
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NPI Number | 1275774366
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Entity Type | Organization
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Legal Business Name | EASTERN WISDOM HEALTH CLINICS, LLC
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | N88W16624 APPLETON AVE STE 7
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2858
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Country | US
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Telephone | 888-802-1388
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Fax |
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Provider Business Mailing Address
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Address Line | 1813 E MENLO BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53211-2517
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JUDY WU
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Credential |
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Telephone | 888-802-1388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 577055
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License Number State | WI
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