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General NPI Number Information
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NPI Number | 1831583665
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Entity Type | Organization
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Legal Business Name | THRIVE WELLNESS
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 2636 OCEAN AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1616
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Country | US
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Telephone | 415-320-6059
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Fax |
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Provider Business Mailing Address
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Address Line | 2636 OCEAN AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-1616
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Country | US
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Telephone | 415-320-6059
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/ OWNER
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Name | CONNIE CHUCK
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Credential | MSTCM, L.AC.
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Telephone | 415-320-6059
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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 | 15344
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License Number State | CA
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