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General NPI Number Information
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NPI Number | 1083438287
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Entity Type | Individual
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Provider Name | THERESA BETH JOHNSON L.AC.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 9241 STARBOARD DR STE C
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City | ROSCOE
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State | IL
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Zip | 61073-6348
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Country | US
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Telephone | 815-227-9429
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Fax |
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Provider Business Mailing Address
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Address Line | 8896 BURR OAK RD
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City | ROSCOE
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State | IL
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Zip | 61073-7870
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Country | US
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Telephone | 828-301-8765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 198.000989
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License Number State | IL
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