Wells Bovard, L.AC.
Individual provider Active NPI Acupuncturist · Deephaven, MN
NPI 1700097151 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1700097151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acupuncturist 171100000X
- License
- 1311 (MN)
- Practice address
- 18142 Minnetonka Blvd.
Deephaven, MN 55391 - Phone
- (952) 345-3335
- NPI assigned
- May 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1311 | MN | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Tree Chiropractic Clinic | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 1311 | MN | Yes |
Addresses
Primary practice location
18142 Minnetonka Blvd.
Deephaven, MN 55391
Mailing address
4409 Columbus Avenue S
Minneapolis, MN 55407-3501
Phone (612) 220-4581
Other providers in Deephaven, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.