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General NPI Number Information
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NPI Number | 1497109839
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Entity Type | Organization
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Legal Business Name | ORIGIN COMPLETE MEDICINE
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 302 JEFFERSON ST STE 170
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City | RALEIGH
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State | NC
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Zip | 27605-3245
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Country | US
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Telephone | 919-412-4131
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Fax |
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Provider Business Mailing Address
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Address Line | 201 MAPLE CREEK CT
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City | APEX
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State | NC
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Zip | 27502-6296
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Country | US
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Telephone | 919-363-5644
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MR. JONATHON KRAMER
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Credential | L.AC
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Telephone | 919-412-4131
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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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