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General NPI Number Information
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NPI Number | 1508256207
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Entity Type | Organization
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Legal Business Name | LUBBOCK INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 3711 20TH ST SUITE B
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City | LUBBOCK
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State | TX
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Zip | 79410-1223
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Country | US
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Telephone | 806-797-7653
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Fax |
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Provider Business Mailing Address
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Address Line | 3711 20TH ST SUITE B
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City | LUBBOCK
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State | TX
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Zip | 79410-1223
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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 | OWNER OF LUBBOCK INTEGRATIVE MEDICI
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Name | DANIEL BLAKE GAFFORD II
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Credential | LAC, MACOM
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Telephone | 806-797-7653
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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 | TX01569
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License Number State | TX
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