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General NPI Number Information
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NPI Number | 1740466739
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Entity Type | Organization
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Legal Business Name | BLUEGRASS TRADITIONAL MEDICINE LLC
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 01/21/2008
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Provider Practice Location Address
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Address Line | 501 DARBY CREEK RD SUITE #12
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City | LEXINGTON
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State | KY
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Zip | 40509-1604
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Country | US
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Telephone | 859-227-1688
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Fax |
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Provider Business Mailing Address
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Address Line | 501 DARBY CREEK RD SUITE #12
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City | LEXINGTON
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State | KY
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Zip | 40509-1604
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Country | US
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Telephone | 859-227-1688
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN KEITH MORGAN
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Credential | C.AC
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Telephone | 859-227-1688
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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 | AC033
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License Number State | KY
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