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General NPI Number Information
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NPI Number | 1174068324
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Entity Type | Organization
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Legal Business Name | BULLOCH INTEGRATIVE HEALTHCARE & ACUPUNCTURE, INC
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Dates
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Enumeration Date | 12/27/2016
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 4132 MADISON AVE
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City | CULVER CITY
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State | CA
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Zip | 90232-3222
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Country | US
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Telephone | 310-428-4841
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Fax |
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Provider Business Mailing Address
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Address Line | 4132 MADISON AVE
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City | CULVER CITY
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State | CA
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Zip | 90232-3222
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Country | US
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Telephone | 310-428-4841
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY BULLOCH
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Credential | D.A.O.M.
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Telephone | 310-428-4841
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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 | AC11576
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License Number State | CA
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