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General NPI Number Information
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NPI Number | 1205429693
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Entity Type | Individual
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Provider Name | GEORGE JACOB ROSENBAUM DIPL. AC., LAC.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 10074 W FAIRVIEW AVE STE 150
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City | BOISE
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State | ID
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Zip | 83704-5002
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Country | US
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Telephone | 540-878-6041
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Fax |
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Provider Business Mailing Address
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Address Line | 1656 S LOGGERS POND PL APT 22
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City | BOISE
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State | ID
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Zip | 83706-7509
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Country | US
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Telephone | 540-878-6041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ACU-408
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License Number State | ID
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