=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285915009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRAGON RISING CHINESE MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2011
-----------------------------------------------------
Last Update Date | 09/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8920 SUNSET AVE STE B
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-6592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-966-1144
-----------------------------------------------------
Fax | 916-966-1141
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8920 SUNSET AVE STE B
-----------------------------------------------------
City | FAIR OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95628-6592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-966-1144
-----------------------------------------------------
Fax | 916-966-1141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ACUPUNCTURIST/OWNER
-----------------------------------------------------
Name | MR. BOB MCCALLISTER
-----------------------------------------------------
Credential | LAC.
-----------------------------------------------------
Telephone | 916-966-1144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 10242
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------