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General NPI Number Information
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NPI Number | 1437293636
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Entity Type | Organization
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Legal Business Name | LIVING WELL ACUPUNCTURE
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1905 KNOX MCRAE DR
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City | TITUSVILLE
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State | FL
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Zip | 32780-5359
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Country | US
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Telephone | 321-268-9433
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Fax | 321-383-0405
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Provider Business Mailing Address
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Address Line | 1905 KNOX MCRAE DR
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City | TITUSVILLE
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State | FL
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Zip | 32780-5359
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Country | US
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Telephone | 321-268-9433
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Fax | 321-383-0405
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Authorized Official
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Title or Position | MANAGER
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Name | DAYNE DEEDS
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Credential | DC
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Telephone | 321-268-9433
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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 | AP 2301
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License Number State | FL
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