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General NPI Number Information
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NPI Number | 1568743102
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE ACUPUNCTURE, PLLC
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 1810 8TH AVE SUITE B
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City | FORT WORTH
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State | TX
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Zip | 76110-1352
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Country | US
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Telephone | 817-913-2421
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 6TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76110-3434
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Country | US
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Telephone | 817-913-2421
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED ACUPUNCTURIST
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Name | CAMERON M SZOK
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Credential | L.AC.
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Telephone | 817-913-2421
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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 | AC01294
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License Number State | TX
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