MEDICARE: TONYA CANDICE WEBER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	95	SC

General Provider Information

NPI Number	:	1295381531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA CANDICE WEBER

Provider Business Mailing Address
First Line	:	2051 MARSH FLOWER LN
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-6435
Country	:	US
Telephone Number	:	843-653-8901
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 2ND AVE N STE 205
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3288
Country	:	US
Telephone Number	:	843-653-8007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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