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General NPI Number Information
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NPI Number | 1760352512
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Entity Type | Organization
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Legal Business Name | THE CRUNCHY ALLERGIST, LLC DBA IMMUNE CONFIDENT INSTITUTE
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 4618 SAWMILL RD
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City | COLUMBUS
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State | OH
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Zip | 43220-2247
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Country | US
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Telephone | 740-954-6278
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Fax | 740-730-4175
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Provider Business Mailing Address
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Address Line | 4618 SAWMILL RD
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City | COLUMBUS
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State | OH
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Zip | 43220-2247
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Country | US
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Telephone | 740-954-6278
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Fax | 740-730-4175
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Authorized Official
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Title or Position | CEO/PHYSICIAN
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Name | KARA JANE WADA
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Credential | MD
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Telephone | 309-550-4273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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