Lake Norman Integrative Wellness, LLC
Clinic/Center, Medical Specialty in Cornelius, NC. Organization (NPI-2).
NPI number1356961007
StatusActive
Last updated in NPPESApr 23, 2020
Details
- NPI
- 1356961007
- Entity type
- Organization (NPI-2)
- Legal business name
- Lake Norman Integrative Wellness, LLC
- Organization subpart
- No
- Enumeration date
- Apr 23, 2020
- Certification date
- Apr 23, 2020
- Last updated
- Apr 23, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM2500X | Clinic/Center, Medical Specialty | – | – | Yes |
Practice location
21000 Torrence Chapel Rd Ste 101Cornelius, NC 28031-6874
Phone 704-987-3993 · Fax 704-987-3991
Mailing address
21000 Torrence Chapel Rd Ste 101Cornelius, NC 28031-6874
Phone 704-987-3993 · Fax 704-987-3991
Authorized official
Akiba Joseph Green
Clinic Director
7046587350
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