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General NPI Number Information
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NPI Number | 1609250919
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE SPECIALISTS LLC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 838 MAIN ST
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City | MONROE
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State | CT
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Zip | 06468-2834
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Country | US
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Telephone | 203-880-5165
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Fax |
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Provider Business Mailing Address
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Address Line | 11 CANTERBURY LN
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City | EASTON
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State | CT
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Zip | 06612-1263
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Country | US
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Telephone | 917-939-5245
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAX KALKSTEIN
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Credential | L.AC.
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Telephone | 203-880-5165
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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 | 148
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License Number State | CT
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