Healthcare Provider Details

I. General information

NPI: 1497341382
Provider Name (Legal Business Name): BACK TO CENTER ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BROAD ST STE 205
BERLIN MD
21811-1055
US

IV. Provider business mailing address

PO BOX 973
WESTMINSTER MD
21158-0973
US

V. Phone/Fax

Practice location:
  • Phone: 443-844-7650
  • Fax: 410-848-5629
Mailing address:
  • Phone: 410-848-5785
  • Fax: 410-848-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ALISON LEINER
Title or Position: PROVIDER
Credential: LAC
Phone: 443-844-7650