=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033423884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DC ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2010
-----------------------------------------------------
Last Update Date | 04/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1740 WISCONSIN AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20007-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-321-2923
-----------------------------------------------------
Fax | 202-333-7667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1932 35TH PL NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20007-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-321-2923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | BRONWYN DALTON CLARK
-----------------------------------------------------
Credential | M.AC, L.AC, DIPLAC
-----------------------------------------------------
Telephone | 202-321-2923
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | AC500090
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------