Healthcare Provider Details

I. General information

NPI: 1902019045
Provider Name (Legal Business Name): KEVIN MICHAEL MUTCHLER L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 GEORGIA AVE SUITE 404
SILVER SPRING MD
20910-3618
US

IV. Provider business mailing address

7014 WOODLAND AVE
TAKOMA PARK MD
20912-4563
US

V. Phone/Fax

Practice location:
  • Phone: 301-562-0305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberUO1188
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: