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General NPI Number Information
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NPI Number | 1881176097
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Entity Type | Organization
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Legal Business Name | MADISON ACUPUNCTURE & BODYWORK, LLC
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 133 S BUTLER ST STE 201
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City | MADISON
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State | WI
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Zip | 53703-5606
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Country | US
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Telephone | 608-213-3664
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Fax |
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Provider Business Mailing Address
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Address Line | 133 S BUTLER ST STE 201
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City | MADISON
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State | WI
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Zip | 53703-5606
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Country | US
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Telephone | 608-213-3664
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Fax |
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Authorized Official
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Title or Position | OWNER, ACUPUNCTURIST
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Name | MS. JAIME MARIE IRVING
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Credential | LAC, LMT
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Telephone | 608-213-3664
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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 | 744-55
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License Number State | WI
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