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General NPI Number Information
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NPI Number | 1831635499
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Entity Type | Organization
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Legal Business Name | MICHELLE RACINE LAC
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 24 CHURCH ST
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City | WATERTOWN
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State | MA
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Zip | 02472-3851
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Country | US
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Telephone | 603-502-4629
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Fax |
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Provider Business Mailing Address
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Address Line | 52 HARVARD AVE
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City | MEDFORD
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State | MA
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Zip | 02155-3505
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Country | US
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Telephone | 603-502-4629
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE RACINE
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Credential | L.AC.
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Telephone | 603-502-4629
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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 | 268874
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License Number State | MA
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