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General NPI Number Information
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NPI Number | 1902315740
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Entity Type | Organization
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Legal Business Name | HEALTHY LIVING ACUPUNCTURE
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 24600 MILLSTREAM DR STE 340
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City | STONE RIDGE
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State | VA
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Zip | 20105-5686
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Country | US
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Telephone | 571-206-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 6293 ASTER HAVEN CIR
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City | HAYMARKET
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State | VA
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Zip | 20169-6235
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Country | US
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Telephone | 540-267-6562
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN SHORT
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Credential |
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Telephone | 571-206-1577
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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 | 0121000652
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License Number State | VA
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