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General NPI Number Information
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NPI Number | 1396047403
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE WELLNESS MEDICAL CLINIC
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 11/22/2010
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Provider Practice Location Address
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Address Line | 400 TAMIAMI TRL S STE 150
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City | VENICE
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State | FL
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Zip | 34285-2623
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Country | US
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Telephone | 941-586-4064
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Fax |
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Provider Business Mailing Address
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Address Line | 400 TAMIAMI TRL S STE 150
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City | VENICE
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State | FL
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Zip | 34285-2623
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Country | US
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Telephone | 941-586-4064
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF ORIENTAL MEDICINE
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Name | MS. MELODY CLANCY
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Credential | L, AC. , D.O.M,.
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Telephone | 941-586-4064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2422
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License Number State | FL
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