=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174820708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARLBOROUGH WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2011
-----------------------------------------------------
Last Update Date | 11/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14A WINTHROP STREET
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-460-3399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 WINTHROP ST
-----------------------------------------------------
City | MARLBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01752-2146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-460-3399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JULIE A. BROWN DALBEC
-----------------------------------------------------
Credential | MAOM, LIC. AC.
-----------------------------------------------------
Telephone | 508-460-3399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 226473
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------