Provider Demographics
NPI:1639880149
Name:WELLSPRING INTEGRATIVE HEALTH & ACUPUNCTURE
Entity Type:Organization
Organization Name:WELLSPRING INTEGRATIVE HEALTH & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, ND
Authorized Official - Phone:707-492-5356
Mailing Address - Street 1:101 ORETSKY WAY
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-5327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 PETALUMA AVE STE 2E
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4234
Practice Address - Country:US
Practice Address - Phone:707-492-5356
Practice Address - Fax:707-492-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty