Healthcare Provider Details

I. General information

NPI: 1104956671
Provider Name (Legal Business Name): ROCKY COAST FAMILY ACUPUNCTURE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOREST AVE SUITE 2A
PORTLAND ME
04101-1541
US

IV. Provider business mailing address

500 FOREST AVE SUITE 2A
PORTLAND ME
04101-1541
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-2059
  • Fax:
Mailing address:
  • Phone: 207-775-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC237
License Number StateME

VIII. Authorized Official

Name: JASON SHER STEIN
Title or Position: PRESIDENT
Credential: L.AC.
Phone: 207-775-2059