Basic Information
| Provider Information | |||||||||
| NPI: | 1720331994 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WENDY WEINTROB INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GLOW ACUPUNCTURE AND NATUROPATHIC MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 NW ARIZONA AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977013298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413129838 | ||||||||
| FaxNumber: | 5413129839 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 NW ARIZONA AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977013298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413129838 | ||||||||
| FaxNumber: | 5413129839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2012 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | WEINTROB | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5413129838 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ND, LAC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.