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General NPI Number Information
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NPI Number | 1043422983
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Entity Type | Organization
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Legal Business Name | ISLANDS ACUPUNCTURE, P.S
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 453 NORTH BEACH RD.
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City | EASTSOUND
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State | WA
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Zip | 98245
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Country | US
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Telephone | 360-376-4002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 291
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City | EASTSOUND
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State | WA
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Zip | 98245-0291
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Country | US
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Telephone | 360-376-4002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CARL I. VAN GELDER
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Credential | L. AC.
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Telephone | 360-376-4002
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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 | AC40
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License Number State | WA
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