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General NPI Number Information
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NPI Number | 1336507177
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Entity Type | Organization
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Legal Business Name | SEA OF QI FAMILY MEDICINE
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 5967 MICHAUX ST
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City | BOCA RATON
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State | FL
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Zip | 33433-7201
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Country | US
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Telephone | 954-684-7449
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N FEDERAL HWY SUITE 110
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City | BOCA RATON
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State | FL
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Zip | 33432-2755
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER BROADWELL
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Credential | AP
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Telephone | 954-684-7449
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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 | AP3041
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License Number State | FL
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