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General NPI Number Information
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NPI Number | 1346963253
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Entity Type | Organization
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Legal Business Name | MIRA INTEGRATIVE CLINIC
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 2557 CHAIN BRIDGE RD
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City | VIENNA
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State | VA
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Zip | 22181-5517
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Country | US
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Telephone | 703-705-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 CHAIN BRIDGE RD
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City | VIENNA
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State | VA
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Zip | 22181-5302
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Country | US
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Telephone | 703-732-9915
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | DR. MAYSOUN HAMID MIRA
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Credential | MD, MSA, L.AC
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Telephone | 703-732-9915
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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 |
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License Number State |
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