Provider Demographics
NPI:1407241060
Name:WHEELER, MICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 6TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLAWNOX
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3238
Mailing Address - Country:US
Mailing Address - Phone:508-364-4828
Mailing Address - Fax:
Practice Address - Street 1:237 6TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BLAWNOX
Practice Address - State:PA
Practice Address - Zip Code:15238-3238
Practice Address - Country:US
Practice Address - Phone:508-364-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist