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General NPI Number Information
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NPI Number | 1922639921
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Entity Type | Organization
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Legal Business Name | 321 ACUPUNCTURE LLC
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 5200 BABCOCK ST NE STE 201
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City | PALM BAY
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State | FL
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Zip | 32905-4644
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Country | US
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Telephone | 407-572-5849
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Fax |
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Provider Business Mailing Address
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Address Line | 871 HAWAII AVE NW
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City | PALM BAY
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State | FL
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Zip | 32907-7763
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Country | US
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Telephone | 407-572-5849
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURE PHYSICIAN
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Name | SHANE J BURR
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Credential | LAC
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Telephone | 407-572-5849
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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 |
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License Number State |
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