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General NPI Number Information
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NPI Number | 1790219632
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Entity Type | Organization
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Legal Business Name | ALL SEASONS ACUPUNCTURE & WELLNESS, LLC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 222 N LAFAYETTE ST STE 24
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City | SHELBY
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State | NC
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Zip | 28150-4450
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Country | US
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Telephone | 980-404-9477
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Fax | 704-495-6681
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Provider Business Mailing Address
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Address Line | 222 N LAFAYETTE ST STE 24
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City | SHELBY
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State | NC
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Zip | 28150-4450
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Country | US
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Telephone | 980-404-9477
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Fax | 704-495-6681
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Authorized Official
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Title or Position | OWNER
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Name | AUTUM KIRGAN
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Credential | L.AC
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Telephone | 980-404-9477
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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 | NCALB 836
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License Number State | NC
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