=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497912364
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TURTLE DRAGON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2008
-----------------------------------------------------
Last Update Date | 09/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1307 E 38TH 1/2 ST
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78722-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-687-0482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1307 E 38TH 1/2 ST
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78722-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-687-0482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | JAMES PHILLIPS
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 512-687-0482
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------