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General NPI Number Information
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NPI Number | 1245499359
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Entity Type | Organization
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Legal Business Name | EVERGREEN TCM, INC
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 209 BEDFORD RD STE 160
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City | BEDFORD
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State | TX
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Zip | 76022-6200
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Country | US
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Telephone | 817-590-8188
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Fax |
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Provider Business Mailing Address
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Address Line | 209 BEDFORD RD STE 160
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City | BEDFORD
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State | TX
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Zip | 76022-6200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WINNIE Y AU
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Credential |
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Telephone | 817-590-8188
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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 | AC00630
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License Number State | TX
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