Provider Demographics
NPI:1942950274
Name:WILD OAK WELLNESS PC
Entity Type:Organization
Organization Name:WILD OAK WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DSOM, LAC
Authorized Official - Phone:208-643-2846
Mailing Address - Street 1:520 E COEUR D ALENE AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2873
Mailing Address - Country:US
Mailing Address - Phone:208-643-2846
Mailing Address - Fax:
Practice Address - Street 1:520 E COEUR D ALENE AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2873
Practice Address - Country:US
Practice Address - Phone:208-643-2846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty