=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689014342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS EDWARD AHLBORN PH.D. LAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2013
-----------------------------------------------------
Last Update Date | 06/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 CIVIC DR SUITE 111
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94596-3895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-977-1638
-----------------------------------------------------
Fax | 925-977-1639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1735 WESTWOOD DR
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94521-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-826-9102
-----------------------------------------------------
Fax | 925-977-1639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 15264
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------