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General NPI Number Information
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NPI Number | 1275036113
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Entity Type | Organization
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Legal Business Name | MACUPUNCTURE
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 222 W YAMATO RD STE 106-169
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City | BOCA RATON
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State | FL
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Zip | 33431-4704
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Country | US
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Telephone | 407-978-0997
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Fax |
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Provider Business Mailing Address
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Address Line | 222 W YAMATO RD STE 106-169
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City | BOCA RATON
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State | FL
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Zip | 33431-4704
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Country | US
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Telephone | 407-978-0997
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DAVID MACIVOR
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Credential | D.O.M., A.P.
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Telephone | 407-978-0997
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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 | AP1840
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License Number State | FL
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