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General NPI Number Information
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NPI Number | 1538508759
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE ORIENTAL MEDICINE LLC
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 2247 PALM BEACH LAKES BLVD SUITE 204B
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-3470
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Country | US
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Telephone | 561-889-6662
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Fax |
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Provider Business Mailing Address
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Address Line | 5560A N OCEAN BLVD
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City | OCEAN RIDGE
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State | FL
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Zip | 33435-7038
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Country | US
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Telephone | 561-889-6662
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURE PHYSICIAN
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Name | DANIEL ROGER LEWIS
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Credential |
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Telephone | 561-889-6662
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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 | AP1583
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License Number State | FL
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