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General NPI Number Information
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NPI Number | 1063290591
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Entity Type | Organization
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Legal Business Name | EQUILBRATE ACUPUNCTURE
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1451 W 11TH ST
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City | TRACY
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State | CA
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Zip | 95376-3733
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Country | US
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Telephone | 650-784-8422
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Fax |
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Provider Business Mailing Address
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Address Line | 2181 N.TRACY BLVD, SUITE 247 SUITE 247
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City | TRACY
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State | CA
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Zip | 95376
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Country | US
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Telephone | 165-078-4842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LANIE QUAN
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Credential | LAC
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Telephone | 650-784-8422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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