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General NPI Number Information
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NPI Number | 1366781890
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Entity Type | Organization
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Legal Business Name | SEASIDE ACUPUNCTURE LLC
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 5155 CORPORATE WAY
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City | JUPITER
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State | FL
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Zip | 33458-4356
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Country | US
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Telephone | 561-693-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 1513 BERKSHIRE AVE
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City | JUPITER
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State | FL
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Zip | 33469-3103
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Country | US
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Telephone | 561-693-4460
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURE PHYSICIAN
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Name | MS. GINA BLITON
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Credential | A.P.
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Telephone | 561-693-4460
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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 | AP2297
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License Number State | FL
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