Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 161529 | AZ |
NPI | 1003269986 |
---|---|
Provider Name | Damon Tallcouch |
First Address | Scottsdale, AZ 85251-6435 |
Second Address | Scottsdale, AZ 85251-6435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2016 |
Last Update Date | 15/07/2016 |