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General NPI Number Information
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NPI Number | 1447586946
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Entity Type | Organization
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Legal Business Name | GEORGETOWN ACUPUNCTURE AND HERBS
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 1915 S AUSTIN AVE SUITE 102
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City | GEORGETOWN
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State | TX
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Zip | 78626-7843
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Country | US
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Telephone | 512-868-2757
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 S AUSTIN AVE SUITE 102
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City | GEORGETOWN
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State | TX
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Zip | 78626-7843
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KENICHI NISHIYA
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Credential | L.AC
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Telephone | 512-868-2757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AC00922
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License Number State | TX
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