Individual
DWIGHT DANSEREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1319 N GOVERNMENT WAY, COEUR D ALENE, ID 83814-3252
(208) 667-3813
Mailing address
1319 N GOVERNMENT WAY, COEUR D ALENE, ID 83814-3252
(208) 667-3813
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-664
ID
Other
Enumeration date
10/02/2014
Last updated
10/02/2014
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