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General NPI Number Information
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NPI Number | 1740610666
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Entity Type | Organization
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Legal Business Name | LIVE OAK ACUPUPUNCTURE & HERBAL MEDICINE, PLLC
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 201 OLD HEWITT ROAD SUITE D
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City | WACO
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State | TX
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Zip | 76712
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Country | US
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Telephone | 254-741-6030
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Fax |
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Provider Business Mailing Address
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Address Line | 201 OLD HEWITT ROAD SUITE D
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City | WACO
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State | TX
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Zip | 76712
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Country | US
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Telephone | 254-741-6030
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN HORNER WARREN
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Credential | L.AC.
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Telephone | 254-741-6030
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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 | AC00703
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License Number State | TX
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