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General NPI Number Information
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NPI Number | 1871046755
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Entity Type | Organization
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Legal Business Name | PROACTIVE ACUPUNCTURE INC
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 2401 CAPITOL AVE STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95816-5884
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Country | US
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Telephone | 916-444-6047
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Fax | 916-444-3394
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Provider Business Mailing Address
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Address Line | 2401 CAPITOL AVE STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95816-5884
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Country | US
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Telephone | 916-444-6047
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Fax | 916-444-3394
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | BRADEY ALLEN CIMINO
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Credential | LAC 10821
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Telephone | 916-444-6047
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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 |
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License Number State |
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