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General NPI Number Information
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NPI Number | 1376998518
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Entity Type | Organization
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Legal Business Name | CHINN QIGONG & ACUPUNCTURE
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 130 LA CASA VIA STE 101
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3065
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Country | US
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Telephone | 925-759-2319
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Fax | 925-687-1990
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Provider Business Mailing Address
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Address Line | 130 LA CASA VIA STE 101
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3065
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Country | US
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Telephone | 925-759-2319
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Fax | 925-687-1990
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Authorized Official
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Title or Position | OWNER/OPERATOR & QIGONG HEALER
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Name | MR. JACOB CHINN
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Credential | L.AC, MSTCM, CMQ
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Telephone | 925-759-2319
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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 | AC13669
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License Number State | CA
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