=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730856337
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILTBRAND ACUPUNCTURE & CHINESE MEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2021
-----------------------------------------------------
Last Update Date | 08/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2825 80TH AVE SE STE 1
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040-2977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-466-1024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4457 E MERCER WAY
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040-3827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-256-4592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | RORY HILTBRAND
-----------------------------------------------------
Credential | DACM, LAC
-----------------------------------------------------
Telephone | 206-466-1024
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------