Healthcare Provider Details

I. General information

NPI: 1790360113
Provider Name (Legal Business Name): RESTORATION ACUPUNCTURE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 N 7TH ST
VINCENNES IN
47591-3107
US

IV. Provider business mailing address

903 N 7TH ST
VINCENNES IN
47591-3107
US

V. Phone/Fax

Practice location:
  • Phone: 812-255-0277
  • Fax: 812-255-0272
Mailing address:
  • Phone: 812-255-0277
  • Fax: 812-255-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: KALEY DECKER
Title or Position: ORNER, ACUPUNCTURIST
Credential: L.AC.
Phone: 812-255-0277