=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154731370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSTAINING HEALTH ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2014
-----------------------------------------------------
Last Update Date | 03/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2985 LIBERTY RD UNIT 14104
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-4620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-475-6841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2985 LIBERTY RD UNIT 14104
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-4620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-475-6841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JACQUELINE KINZIG
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 859-475-6841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------