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General NPI Number Information
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NPI Number | 1003620220
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Entity Type | Organization
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Legal Business Name | TIDEWATER ACUPUNCTURE AND WELLNESS
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 2272 W GREAT NECK RD STE 2244
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1506
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Country | US
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Telephone | 757-589-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 2676 RIVER RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-1223
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Country | US
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Telephone | 757-589-2880
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER SADLER
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Credential | LAC
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Telephone | 757-589-2880
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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 |
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License Number State |
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