Healthcare Provider Details

I. General information

NPI: 1871962712
Provider Name (Legal Business Name): ACUPUNCTURE AND WELLNESS OF THE PALM BEACHES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S STATE ROAD 7 STE 315-27
WELLINGTON FL
33414-6134
US

IV. Provider business mailing address

5779 AUTUMN RIDGE RD
LAKE WORTH FL
33463-6745
US

V. Phone/Fax

Practice location:
  • Phone: 561-267-6464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3321
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA53396
License Number StateFL

VIII. Authorized Official

Name: LEANNE MITCHELL
Title or Position: PRESIDENT
Credential: DIPL. L.AC.
Phone: 561-267-6464