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General NPI Number Information
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NPI Number | 1326482233
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Entity Type | Individual
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Provider Name | MATTHEW S SAFARIK LAC, CMT
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Gender | Male
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 6314 ODANA RD STE 22
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City | MADISON
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State | WI
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Zip | 53719-1194
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Country | US
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Telephone | 310-991-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 WICKLOW WAY
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City | MADISON
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State | WI
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Zip | 53711-3666
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Country | US
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Telephone | 310-991-9797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | AC 15120
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License Number State | CA
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