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General NPI Number Information
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NPI Number | 1659768687
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Entity Type | Organization
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Legal Business Name | ELEVATE WELLNESS AND ACUPUNCTURE CENTER
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 2244 BARTON AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3408
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Country | US
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Telephone | 530-541-9355
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Fax | 530-541-9350
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Provider Business Mailing Address
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Address Line | 2244 BARTON AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3408
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Country | US
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Telephone | 530-541-9355
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Fax | 530-541-9350
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | MELIDNA CHOY
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Credential | LAC
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Telephone | 530-541-9355
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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 | 9696
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License Number State | CA
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