Provider Demographics
NPI:1891279196
Name:WILD WELLNESS INTEGRATIVE MEDICINE, LLC
Entity type:Organization
Organization Name:WILD WELLNESS INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NMD
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-494-3775
Mailing Address - Street 1:437 W THURBER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-6821
Mailing Address - Country:US
Mailing Address - Phone:520-494-3775
Mailing Address - Fax:
Practice Address - Street 1:437 W THURBER RD STE 3
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6821
Practice Address - Country:US
Practice Address - Phone:520-494-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty