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General NPI Number Information
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NPI Number | 1609172816
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Entity Type | Individual
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Provider Name | ELAINE KATHRYN BYNUM L.AC., C.M.T.
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Gender | Female
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 129 N HALCYON RD STE H
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-2587
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Country | US
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Telephone | 805-722-5847
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 888
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City | GROVER BEACH
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State | CA
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Zip | 93483-0888
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Country | US
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Telephone | 805-722-5847
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12292
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License Number State | CA
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