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General NPI Number Information
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NPI Number | 1194195784
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Entity Type | Organization
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Legal Business Name | NATURAL MEDICINE AND PAIN CENTER LLC
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 1215 W BAKER ST
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City | PLANT CITY
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State | FL
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Zip | 33563-4309
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Country | US
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Telephone | 813-996-4773
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Fax |
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Provider Business Mailing Address
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Address Line | 123 S WIGGINS RD
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City | PLANT CITY
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State | FL
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Zip | 33566-7351
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Country | US
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Telephone | 813-996-4773
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALAINA EDGEMON
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Credential | AP
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Telephone | 813-996-4773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP3660
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License Number State | FL
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