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General NPI Number Information
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NPI Number | 1871895425
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Entity Type | Organization
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Legal Business Name | DOWNTOWN CENTER FOR ORIENTAL MEDICINE, PLLC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 211 SW 4TH AVE SUITE 2
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City | GAINESVILLE
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State | FL
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Zip | 32601-1805
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Country | US
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Telephone | 352-226-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 211 SW 4TH AVE SUITE 2
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City | GAINESVILLE
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State | FL
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Zip | 32601-1805
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Country | US
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Telephone | 352-226-4433
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JAMES LEE BROOKS
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Credential | LCSW-R, AP
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Telephone | 352-226-4433
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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 | AP2916, AP 2902
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License Number State | FL
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