=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174833958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PACIFIC GROVE ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2010
-----------------------------------------------------
Last Update Date | 10/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 15TH ST
-----------------------------------------------------
City | PACIFIC GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93950-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-224-7621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 15TH ST
-----------------------------------------------------
City | PACIFIC GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93950-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-224-7621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST, HERBALIST
-----------------------------------------------------
Name | JACQUELYN C. BYRD
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 831-224-7621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 13829
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------