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General NPI Number Information
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NPI Number | 1003350935
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Entity Type | Individual
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Provider Name | ALEXANDER KERWAY TAN L.AC.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 1515 N MAIN ST STE C
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-4923
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Country | US
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Telephone | 888-336-6991
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 E ARROWHEAD AVE
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-5101
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Country | US
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Telephone | 888-336-6991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1054
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License Number State | AZ
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