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General NPI Number Information
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NPI Number | 1720651524
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Entity Type | Organization
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Legal Business Name | TREASURE VALLEY ACUPUNCTURE
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 1433 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8537
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Country | US
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Telephone | 208-994-4889
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Fax |
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Provider Business Mailing Address
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Address Line | 1433 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8537
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Country | US
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Telephone | 208-994-4889
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | SETH SHAMON
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Credential | LAC
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Telephone | 208-329-2110
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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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