=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730504051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANDALL WEGENER ACUPUNCTURIST, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2014
-----------------------------------------------------
Last Update Date | 02/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 593 E ELDER ST STE A
-----------------------------------------------------
City | FALLBROOK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92028-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-451-2188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 593 E ELDER ST STE A
-----------------------------------------------------
City | FALLBROOK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92028-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-451-2188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RANDALL WAYNE WEGENER
-----------------------------------------------------
Credential | L. AC., DIPL. AC.
-----------------------------------------------------
Telephone | 760-451-2188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------