=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902126576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVERY ACUPUNCTURE & NATURAL MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2010
-----------------------------------------------------
Last Update Date | 06/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 939 OAK ST
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446-2580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-400-9652
-----------------------------------------------------
Fax | 805-400-9652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 939 OAK ST
-----------------------------------------------------
City | PASO ROBLES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93446-2580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-400-9652
-----------------------------------------------------
Fax | 805-400-9652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ACUPUNCTURIST
-----------------------------------------------------
Name | VERONICA E AVERY
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 805-400-9652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 13614
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------