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General NPI Number Information
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NPI Number | 1861940678
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Entity Type | Organization
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Legal Business Name | LIFESTYLE ACUPUNCTURE OF NEW JERSEY
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 471 GLEN RD
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City | SPARTA
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State | NJ
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Zip | 07871-3114
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Country | US
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Telephone | 973-919-6674
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Fax |
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Provider Business Mailing Address
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Address Line | 471 GLEN RD
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City | SPARTA
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State | NJ
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Zip | 07871-3114
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Country | US
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Telephone | 973-919-6674
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED ACUPUNCTURIST
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Name | KAYLEIGH LAVENDER CALLAN
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Credential | L.AC.
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Telephone | 973-919-6674
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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 | 25MZ00095600
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License Number State | NJ
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