=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376104208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACUWELL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2019
-----------------------------------------------------
Last Update Date | 06/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 E OGDEN AVE
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-3159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-283-8817
-----------------------------------------------------
Fax | 630-358-6433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 E OGDEN AVE
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-3159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-283-8817
-----------------------------------------------------
Fax | 630-358-6433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAMANTHA SHORE
-----------------------------------------------------
Credential | ND, MSOM, LAC
-----------------------------------------------------
Telephone | 630-283-8817
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------