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General NPI Number Information
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NPI Number | 1356858955
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Entity Type | Organization
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Legal Business Name | BLAKELY ACUPUNCTURE
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 401 E 6TH AVE
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City | BELTON
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State | TX
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Zip | 76513-2667
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Country | US
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Telephone | 254-939-5801
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Fax |
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Provider Business Mailing Address
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Address Line | 401 E 6TH AVE
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City | BELTON
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State | TX
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Zip | 76513-2667
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Country | US
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Telephone | 254-939-5801
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM D BLAKELY
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Credential | L.AC
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Telephone | 512-630-7278
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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 | AC00232
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License Number State | TX
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