=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417499005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACUPUNCTURE & HOLISTIC HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2016
-----------------------------------------------------
Last Update Date | 11/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2998 CHARLESTON RD STE 5
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25271-5810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-786-1007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2998 CHARLESTON RD STE 5
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25271-5810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-786-1007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICIA M LINK
-----------------------------------------------------
Credential | L. AC.
-----------------------------------------------------
Telephone | 304-786-1007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 96217
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------