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General NPI Number Information
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NPI Number | 1932607504
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Entity Type | Organization
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Legal Business Name | INTEGRATED ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 4701 SANGAMORE RD STE N270
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City | BETHESDA
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State | MD
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Zip | 20816-2528
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Country | US
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Telephone | 240-507-5110
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Fax | 844-682-8102
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Provider Business Mailing Address
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Address Line | 41869 DUBLANE PL
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City | ASHBURN
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State | VA
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Zip | 20148-8038
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Country | US
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Telephone | 240-498-9979
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MR. MICHAEL CORY JECMEN
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Credential | L.AC.
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Telephone | 240-498-9979
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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 | U0172
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License Number State | MD
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