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General NPI Number Information
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NPI Number | 1275201774
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Entity Type | Organization
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Legal Business Name | A&C CLINICAL MANIPULATION, LLC
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 1033 STERLING RD STE 105
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City | HERNDON
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State | VA
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Zip | 20170-3837
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Country | US
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Telephone | 703-855-3514
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Fax |
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Provider Business Mailing Address
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Address Line | 5104 CASTLE HARBOR WAY
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City | CENTREVILLE
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State | VA
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Zip | 20120-4140
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Country | US
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Telephone | 703-855-3514
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST / OWNER
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Name | KIYOSHI YAMAMOTO
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Credential | LAC., LMT
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Telephone | 703-855-3514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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