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General NPI Number Information
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NPI Number | 1558633164
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Entity Type | Organization
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Legal Business Name | JEON'S ACUPUNCTURE, HEALTH EDUCATION & NATURAL MEDICINE CENTER, INC
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 2235 S BROADWAY AVE
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City | BOISE
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State | ID
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Zip | 83706-4617
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Country | US
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Telephone | 208-901-1956
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Fax |
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Provider Business Mailing Address
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Address Line | 2235 S BROADWAY AVE
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City | BOISE
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State | ID
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Zip | 83706-4617
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Country | US
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Telephone | 208-901-1956
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EUNICE YEONSEUNG JEON
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Credential | MSOM, L.AC
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Telephone | 208-901-1956
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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 | ACU-275
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License Number State | ID
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