Provider Demographics
NPI:1689795791
Name:RIVERWALK NATURAL HEALTH CLINIC AND NATURAL PHARMACY LLC
Entity Type:Organization
Organization Name:RIVERWALK NATURAL HEALTH CLINIC AND NATURAL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIANCEK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:970-926-7606
Mailing Address - Street 1:280 MAIN ST UNIT C-105
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8501
Mailing Address - Country:US
Mailing Address - Phone:970-926-7606
Mailing Address - Fax:970-926-7606
Practice Address - Street 1:280 MAIN ST UNIT C-105
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-8501
Practice Address - Country:US
Practice Address - Phone:970-926-7606
Practice Address - Fax:970-926-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA846175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty