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General NPI Number Information
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NPI Number | 1225453186
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE CARE MEDWAY
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 16 CAUSEWAY ST
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City | MEDWAY
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State | MA
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Zip | 02053-2420
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Country | US
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Telephone | 508-533-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 16 CAUSEWAY ST
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City | MEDWAY
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State | MA
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Zip | 02053-2420
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Country | US
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Telephone | 508-533-1234
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MR. JOSHUA ADAM GRANT
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Credential | LIC.AC.
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Telephone | 508-533-1234
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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 | 496
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License Number State | MA
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