Healthcare Provider Details

I. General information

NPI: 1992822886
Provider Name (Legal Business Name): CARL B EKLUND L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 E BROADWAY
LONG BEACH CA
90803-6105
US

IV. Provider business mailing address

3646 RADNOR AVE
LONG BEACH CA
90808-2757
US

V. Phone/Fax

Practice location:
  • Phone: 562-433-5868
  • Fax: 562-420-6706
Mailing address:
  • Phone: 562-433-5868
  • Fax: 562-420-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: