=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205066677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITESPIRE CENTER OF ORIENTAL MEDICINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2009
-----------------------------------------------------
Last Update Date | 07/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 EXCHANGE ST NW SUITE 114
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28027-2934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-723-4015
-----------------------------------------------------
Fax | 704-721-0147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 EXCHANGE ST NW SUITE 114
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28027-2934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-723-4015
-----------------------------------------------------
Fax | 704-721-0147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MARGOT C DRAGON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-723-4015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 493
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------