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General NPI Number Information
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NPI Number | 1790029650
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Entity Type | Organization
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Legal Business Name | AWAKENINGS ACUPUNCTURE & HERBAL CLINIC, LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 9751 N GOVERNMENT WAY STE 1
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City | HAYDEN
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State | ID
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Zip | 83835-9645
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Country | US
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Telephone | 208-660-6777
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Fax | 208-772-7737
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Provider Business Mailing Address
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Address Line | 9751 N GOVERNMENT WAY STE 1
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City | HAYDEN
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State | ID
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Zip | 83835-9645
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Country | US
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Telephone | 208-660-6777
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Fax | 208-772-7737
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Authorized Official
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Title or Position | MANAGER
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Name | MS. JEANETTE K. MORRIS
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Credential | LAC
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Telephone | 208-660-6777
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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 | ACU-206
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License Number State | ID
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