=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306022207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACUPUNCTURE MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2008
-----------------------------------------------------
Last Update Date | 01/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 716 CHELSEA BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-6206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-942-9688
-----------------------------------------------------
Fax | 713-942-9335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 716 CHELSEA BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-6206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-942-9688
-----------------------------------------------------
Fax | 713-942-9335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIAN JOSEPH MCKENNA
-----------------------------------------------------
Credential | DOM, LIC.AC.
-----------------------------------------------------
Telephone | 713-942-9688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC00410
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------