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General NPI Number Information
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NPI Number | 1063956217
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Entity Type | Organization
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Legal Business Name | BLUEGREEN ACUPUNCTURE & BODYWORK LLC
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 222 W COLD SPRING LN STE B
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City | BALTIMORE
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State | MD
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Zip | 21210-2800
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Country | US
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Telephone | 443-939-4834
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Fax |
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Provider Business Mailing Address
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Address Line | 222 W COLD SPRING LN STE B
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City | BALTIMORE
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State | MD
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Zip | 21210-2800
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Country | US
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Telephone | 443-939-4834
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIN E MITCHELL
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Credential |
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Telephone | 443-939-4834
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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 | U01809
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License Number State | MD
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