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General NPI Number Information
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NPI Number | 1245724418
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Entity Type | Organization
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Legal Business Name | NORCAL INTEGRATIVE PAIN CARE, PC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 2131 CAPITOL AVE STE 307
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City | SACRAMENTO
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State | CA
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Zip | 95816-5755
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Country | US
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Telephone | 916-444-2177
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Fax |
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Provider Business Mailing Address
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Address Line | 2131 CAPITOL AVE STE 307
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City | SACRAMENTO
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State | CA
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Zip | 95816-5755
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Country | US
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Telephone | 916-444-2177
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Fax |
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Authorized Official
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Title or Position | CEO/ACUPUNCTURIST
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Name | MR. KENNETH CHARLES BERRY III
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Credential | LAC
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Telephone | 916-444-2177
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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 | 11845
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License Number State | CA
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