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General NPI Number Information
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NPI Number | 1376022939
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Entity Type | Organization
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Legal Business Name | NEUROSPORT ACUPUNCTURE LLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 2949 WALNUT BLVD
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City | WALNUT CREEK
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State | CA
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Zip | 94596-4941
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Country | US
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Telephone | 925-269-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 2949 WALNUT BLVD
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City | WALNUT CREEK
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State | CA
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Zip | 94596-4941
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Country | US
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Telephone | 925-269-4141
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Fax |
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Authorized Official
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Title or Position | PRACTICE DIRECTOR
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Name | DR. JOEL SMITH
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Credential | L.AC/RN
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Telephone | 925-269-4141
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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 | AC17767
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License Number State | CA
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