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General NPI Number Information
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NPI Number | 1891210878
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Entity Type | Organization
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Legal Business Name | OHIO ACUPUNCTURE AND CHINESE HERBAL MEDICINE, LLC
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 08/10/2017
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Provider Practice Location Address
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Address Line | 100 W 3RD AVE STE 100
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City | COLUMBUS
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State | OH
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Zip | 43201-3256
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Country | US
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Telephone | 614-233-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 104 S ARDMORE RD
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City | BEXLEY
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State | OH
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Zip | 43209-1705
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Country | US
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Telephone | 857-928-8711
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BRETTE LUCK
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Credential | L.AC.
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Telephone | 847-928-8711
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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 | 65.000230
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License Number State | OH
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