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General NPI Number Information
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NPI Number | 1184213993
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Entity Type | Organization
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Legal Business Name | ACACIA NATURAL MEDICINE PLLC
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 13951 N SCOTTSDALE RD STE 110
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-3454
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Country | US
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Telephone | 480-702-1537
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Fax |
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Provider Business Mailing Address
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Address Line | 13951 N SCOTTSDALE RD STE 110
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-3454
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Country | US
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Telephone | 480-702-1537
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BONNIE LYNN BROCK
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Credential | NMD, RD, LDN
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Telephone | 847-903-0503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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