Healthcare Provider Details

I. General information

NPI: 1275955676
Provider Name (Legal Business Name): MICHAEL P. HURLEY JR. MSTOM, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459A FRANCESTOWN RD
NEW BOSTON NH
03070-4705
US

IV. Provider business mailing address

459A FRANCESTOWN RD
NEW BOSTON NH
03070-4705
US

V. Phone/Fax

Practice location:
  • Phone: 603-860-0693
  • Fax:
Mailing address:
  • Phone: 603-860-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACP 219
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: