MEDICARE: BACK & JOINT ALTERNATIVE MEDICINE

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

General Provider Information

NPI Number	:	1467002899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK & JOINT ALTERNATIVE MEDICINE

Provider Business Mailing Address
First Line	:	72875 FRED WARING DR STE B
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-9403
Country	:	US
Telephone Number	:	730-340-0080
Fax Number	:

Provider Business Practice Location Address
First Line	:	72875 FRED WARING DR STE B
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-9403
Country	:	US
Telephone Number	:	730-340-0080
Fax Number	:

Authorized Official
Title or Position	:	LAC, OWNER
Name	:	JONG LEE
Credential	:
Telephone Number	:	760-340-0080

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	09/17/2019

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Directions to “BACK & JOINT ALTERNATIVE MEDICINE ” Practice Location

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