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General NPI Number Information
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NPI Number | 1194231100
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Entity Type | Organization
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Legal Business Name | WELLSPRING COMMUNITY ACUPUNCTURE CORP.
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 318 E JEFFERSON ST
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City | BUTLER
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State | PA
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Zip | 16001-6009
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Country | US
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Telephone | 724-498-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 264 GIBSON RD
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City | PARKER
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State | PA
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Zip | 16049-2018
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Country | US
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Telephone | 724-498-6141
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PRIMARY PROVIDER
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Name | MR. FAE GIBSON
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Credential | M.AC., L.AC., LMT
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Telephone | 724-498-6141
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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 | AK001255
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License Number State | PA
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