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General NPI Number Information
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NPI Number | 1407113665
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Entity Type | Organization
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Legal Business Name | ORIENTAL BODYWORK & ACUPUNCTURE CLINIC, S.C.
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 313 WEST BELTLINE HWY SUITE # 133
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City | MADISON
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State | WI
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Zip | 53713
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Country | US
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Telephone | 262-716-3771
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Fax |
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Provider Business Mailing Address
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Address Line | 313 WEST BELTLINE HWY SUITE # 133
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City | MADISON
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State | WI
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Zip | 53713
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Country | US
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Telephone | 262-716-3771
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TERRENCE RICHARD MASON
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Credential | DIPL. AC.,L. AC.
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Telephone | 262-716-3771
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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 | #160-055
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License Number State | WI
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