Healthcare Provider Details

I. General information

NPI: 1568541779
Provider Name (Legal Business Name): BETH HERZIG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
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

519 STEVENS AVE #1
PORTLAND ME
04103-2637
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-2059
  • Fax:
Mailing address:
  • Phone: 207-671-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC238
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: