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General NPI Number Information
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NPI Number | 1942950274
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Entity Type | Organization
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Legal Business Name | WILD OAK WELLNESS PC
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 520 E COEUR D ALENE AVE UNIT 5
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2873
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Country | US
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Telephone | 208-643-2846
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Fax |
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Provider Business Mailing Address
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Address Line | 520 E COEUR D ALENE AVE UNIT 5
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2873
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Country | US
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Telephone | 208-643-2846
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | DR. DAVID MICHAEL CAMPBELL
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Credential | DSOM, LAC
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Telephone | 208-643-2846
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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 |
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License Number State |
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