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General NPI Number Information
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NPI Number | 1750736146
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE FREDERICKSBURG
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 2358 PLANK RD
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4900
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Country | US
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Telephone | 540-847-6985
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Fax |
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Provider Business Mailing Address
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Address Line | 7206 MILLSTREAM DR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-3313
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Country | US
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Telephone | 540-847-6985
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | EDWARD WOLGRAM VERNON II
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Credential | L.AC.
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Telephone | 540-847-6985
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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 | 0121000544
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License Number State | VA
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