Provider Demographics
NPI:1104857283
Name:WENDT, THOMAS WARREN (LAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WARREN
Last Name:WENDT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720C MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3407
Mailing Address - Country:US
Mailing Address - Phone:530-666-5038
Mailing Address - Fax:530-666-9240
Practice Address - Street 1:720C MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3407
Practice Address - Country:US
Practice Address - Phone:530-666-5038
Practice Address - Fax:530-666-9240
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8292171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist