=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245058106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALLINAN ACUPUNCTURE AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2024
-----------------------------------------------------
Last Update Date | 09/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6040 COMMERCE BLVD STE 103
-----------------------------------------------------
City | ROHNERT PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94928-2181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-852-4182
-----------------------------------------------------
Fax | 707-852-4183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6040 COMMERCE BLVD STE 103
-----------------------------------------------------
City | ROHNERT PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94928-2181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY CALLINAN JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-852-4182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------