=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174924955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. CHARLIE WARE AP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2014
-----------------------------------------------------
Last Update Date | 09/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2632 HOLLYWOOD BLVD SUITE 300
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-4857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-458-5999
-----------------------------------------------------
Fax | 954-458-5990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2632 HOLLYWOOD BLVD SUITE 300
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-4857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-458-5999
-----------------------------------------------------
Fax | 954-458-5990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST/OWNER
-----------------------------------------------------
Name | DR. CHARLIE J. WARE
-----------------------------------------------------
Credential | AP
-----------------------------------------------------
Telephone | 305-498-4483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP2677
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------