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General NPI Number Information
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NPI Number | 1992125645
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Entity Type | Organization
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Legal Business Name | SHALOM ACUPUNCTURE & HERBS CLINIC
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 6954 VAUGHN RD
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City | MONTGOMERY
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State | AL
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Zip | 36116-1368
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Country | US
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Telephone | 334-301-8860
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Fax | 334-512-9979
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Provider Business Mailing Address
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Address Line | 6954 VAUGHN RD
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City | MONTGOMERY
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State | AL
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Zip | 36116-1368
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Country | US
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Telephone | 334-301-8860
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Fax | 334-512-9979
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL PARK
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Credential | ACUPUNCTURE LIST
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Telephone | 256-585-2661
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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 | 3556
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License Number State | AL
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