=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871980946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHINESE HOLISTIC HEALTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2015
-----------------------------------------------------
Last Update Date | 04/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 CARLE AVE
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035-8293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-657-8695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 777 CARLE AVE
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035-8293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-657-8695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | MRS. YIRAN WANG DAVIS
-----------------------------------------------------
Credential | L.AC
-----------------------------------------------------
Telephone | 614-657-8695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 000283
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------