=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831497965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SINO-LEGACY ACUPUNCTURE CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2011
-----------------------------------------------------
Last Update Date | 06/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46164 WARM SPRINGS BLVD UNIT 266
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94539-7985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-623-8787
-----------------------------------------------------
Fax | 510-623-8788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46164 WARM SPRINGS BLVD UNIT 266
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94539-7985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-623-8787
-----------------------------------------------------
Fax | 510-623-8788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DIRECTOR
-----------------------------------------------------
Name | MR. DAMON CHARLES FRACH
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 408-984-2455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC27826
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC0278260
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111NI0013X
-----------------------------------------------------
Taxonomy Name | Independent Medical Examiner Chiropractor
-----------------------------------------------------
License Number | DC18679
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC0066920
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC6692
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC13796
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC2765
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC11584
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------