Healthcare Provider Details

I. General information

NPI: 1720321128
Provider Name (Legal Business Name): JOHN NIETERS, L.AC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 SANTA CLARA AVE STE 1
ALAMEDA CA
94501-4473
US

IV. Provider business mailing address

2258 SANTA CLARA AVE STE 1
ALAMEDA CA
94501-4473
US

V. Phone/Fax

Practice location:
  • Phone: 510-814-6900
  • Fax:
Mailing address:
  • Phone: 510-814-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6599
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN NIETERS
Title or Position: LICENSED ACUPUNCTURIST
Credential: L.AC., DAOM
Phone: 51081409100