=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376710020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN H LESS LIC. AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2008
-----------------------------------------------------
Last Update Date | 05/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 197 SOUTH ST
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-6812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-448-8088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 WENDELL AVE
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-6995
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-448-8088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 204652
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------