=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184986333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRILOGY ACUPUNCTURE WELLNESS CENTER, INC.45
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2012
-----------------------------------------------------
Last Update Date | 06/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8113 E FLORENTINE RD STE A
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-8461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-772-5575
-----------------------------------------------------
Fax | 928-772-5575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8113 E FLORENTINE RD STE A
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-8461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-772-5575
-----------------------------------------------------
Fax | 928-772-5575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BEVERLY K COWAN
-----------------------------------------------------
Credential | DAOM (DR OF ACUPUNCT
-----------------------------------------------------
Telephone | 928-772-5575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------