Provider Demographics
NPI:1326596933
Name:WELL WITHIN
Entity Type:Organization
Organization Name:WELL WITHIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DESURRA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-347-9100
Mailing Address - Street 1:980 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9475
Mailing Address - Country:US
Mailing Address - Phone:541-347-9100
Mailing Address - Fax:541-329-0260
Practice Address - Street 1:980 2ND ST SE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9475
Practice Address - Country:US
Practice Address - Phone:541-347-9100
Practice Address - Fax:541-329-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty