Healthcare Provider Details

I. General information

NPI: 1326456542
Provider Name (Legal Business Name): ELLIOTT ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 WEST ST
REDDING CA
96001-0416
US

IV. Provider business mailing address

1257 WEST ST
REDDING CA
96001-0416
US

V. Phone/Fax

Practice location:
  • Phone: 530-243-5230
  • Fax:
Mailing address:
  • Phone: 530-243-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8025
License Number StateCA

VIII. Authorized Official

Name: MRS. CAMERYN TOWNSEND ELLIOTT
Title or Position: ACUPUNCTURIST
Credential: L.AC.
Phone: 530-243-5230