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General NPI Number Information
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NPI Number | 1376061762
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Entity Type | Organization
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Legal Business Name | BREATH OF LIFE ACUPUNCTURE & WELLNESS PLLC
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 2105 DEMERSE AVE
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City | PRESCOTT
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State | AZ
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Zip | 86301-1013
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Country | US
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Telephone | 928-713-3833
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 DEMERSE AVE
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City | PRESCOTT
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State | AZ
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Zip | 86301-1013
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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 | MEMBER
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Name | JENNIFER ROSEMAN
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Credential |
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Telephone | 928-713-3833
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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 | 1050
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License Number State | AZ
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