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General NPI Number Information
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NPI Number | 1639307150
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE ACUPUNCTURE MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 321 BOCA CIEGA DR
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-2435
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Country | US
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Telephone | 727-398-1861
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Fax | 727-398-1861
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Provider Business Mailing Address
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Address Line | 321 BOCA CIEGA DR
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City | MADEIRA BEACH
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State | FL
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Zip | 33708-2435
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Country | US
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Telephone | 727-398-1861
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Fax | 727-398-1861
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Authorized Official
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Title or Position | MGR
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Name | VICTOR A CUCARO
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Credential | AP
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Telephone | 727-398-1861
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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 |
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License Number State |
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