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General NPI Number Information
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NPI Number | 1407462732
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Entity Type | Organization
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Legal Business Name | EAST WEST INTEGRATED CARE CENTER LLC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 6703 E 81ST ST STE J
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City | TULSA
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State | OK
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Zip | 74133-4157
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Country | US
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Telephone | 918-814-7650
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Fax | 844-249-7650
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Provider Business Mailing Address
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Address Line | 1100 W TUCSON ST APT 801
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City | BROKEN ARROW
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State | OK
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Zip | 74011-7246
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Country | US
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Telephone | 918-814-7650
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Fax | 844-249-7650
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ILDIKO BERCAK
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Credential |
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Telephone | 941-993-6299
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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 |
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License Number State |
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