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General NPI Number Information
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NPI Number | 1164788840
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE AND ORIENTAL MEDICINE CENTER, LLC
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Dates
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Enumeration Date | 04/06/2012
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Last Update Date | 04/06/2012
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Provider Practice Location Address
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Address Line | 2014 FAIRMOUNT AVENUE
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2602
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Country | US
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Telephone | 267-342-5880
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 341
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City | GLENSIDE
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State | PA
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Zip | 19038-9998
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Country | US
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Telephone | 267-342-5880
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/OWNER
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Name | MR. IAN ANTHONY CYRUS
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Credential | L.AC.
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Telephone | 267-342-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AK000397
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License Number State | PA
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