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General NPI Number Information
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NPI Number | 1043106131
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Entity Type | Organization
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Legal Business Name | TRADITIONAL FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 12 VILLAGE RD
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City | BEACH LAKE
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State | PA
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Zip | 18405-9701
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Country | US
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Telephone | 570-352-2385
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Fax |
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Provider Business Mailing Address
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Address Line | 16 VILLAGE RD
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City | BEACH LAKE
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State | PA
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Zip | 18405-9777
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Country | US
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Telephone | 570-352-2385
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA CORRIGAN
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Credential | L.AC
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Telephone | 570-352-2385
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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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