Healthcare Provider Details

I. General information

NPI: 1437619830
Provider Name (Legal Business Name): NEIGHBORHOOD ACUPUNCTURE & HEALING ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12582 S FORT ST
DRAPER UT
84020-9447
US

IV. Provider business mailing address

12582 S FORT ST
DRAPER UT
84020-9447
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-8610
  • Fax:
Mailing address:
  • Phone: 801-662-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD WISELY II
Title or Position: OWNER
Credential: ERYT
Phone: 801-662-8610