Healthcare Provider Details

I. General information

NPI: 1306148531
Provider Name (Legal Business Name): JOSHUA B. VAJCOVEC L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 KING ST SUITE 2C
NORTHAMPTON MA
01060-3284
US

IV. Provider business mailing address

40 ALAMO CT
FLORENCE MA
01062-3423
US

V. Phone/Fax

Practice location:
  • Phone: 413-923-8355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number239502
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: