Healthcare Provider Details

I. General information

NPI: 1356061642
Provider Name (Legal Business Name): TIDEWATER ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ELM ST STE 1B
MANCHESTER BY THE SEA MA
01944-1366
US

IV. Provider business mailing address

58 MARTIN ST
ESSEX MA
01929-1256
US

V. Phone/Fax

Practice location:
  • Phone: 202-744-5480
  • Fax:
Mailing address:
  • Phone: 202-744-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHERINE ROSE ZEIGLER
Title or Position: LICENSED ACUPUNCTURIST
Credential: MAC
Phone: 202-744-5480