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General NPI Number Information
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NPI Number | 1710767298
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Entity Type | Organization
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Legal Business Name | STILL LIFE ACUPUNCTURE
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 213 PIERCE ST
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City | SANTA ROSA
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State | CA
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Zip | 95404-6625
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Country | US
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Telephone | 707-583-3226
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Fax |
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Provider Business Mailing Address
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Address Line | 213 PIERCE ST
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City | SANTA ROSA
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State | CA
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Zip | 95404-6625
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Country | US
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Telephone | 805-458-4506
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Fax |
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Authorized Official
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Title or Position | CEO/TREASURER/SECRETARY
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Name | DANIEL STOLPER
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Credential | L.AC.
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Telephone | 707-583-3226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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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 | 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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