=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154544203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH ELDER NEELY R.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 254 N MAIN ST
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16346-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-677-3062
-----------------------------------------------------
Fax | 814-677-6282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 254 N MAIN ST
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16346-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-677-3062
-----------------------------------------------------
Fax | 814-677-6282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | KO000086L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------