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General NPI Number Information
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NPI Number | 1689135964
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Entity Type | Organization
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Legal Business Name | HOLISTIC HEALTH & DETOX CENTER, LLC
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 2016 S ELIZABETH ST
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City | KOKOMO
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State | IN
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Zip | 46902-2430
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Country | US
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Telephone | 765-450-4776
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Fax | 765-450-4776
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Provider Business Mailing Address
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Address Line | 2016 S ELIZABETH ST
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City | KOKOMO
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State | IN
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Zip | 46902-2430
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Country | US
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Telephone | 765-450-4776
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Fax | 765-450-4776
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MIKA J FUJII
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Credential | MD
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Telephone | 765-450-4776
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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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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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