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General NPI Number Information
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NPI Number | 1306315056
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE WELLNESS INSTITUTE INC
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Dates
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Enumeration Date | 11/23/2018
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 2182 BROADWAY AVE
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City | NORTH BEND
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State | OR
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Zip | 97459
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Country | US
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Telephone | 541-808-9697
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Fax | 541-808-9699
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Provider Business Mailing Address
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Address Line | 2590 VIRGINIA AVE
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City | NORTH BEND
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State | OR
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Zip | 97459-1741
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Country | US
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Telephone | 630-205-9000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL PATRICK BARTELL
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Credential | D.C.
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Telephone | 630-205-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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