MEDICARE: TRI-CITIES ACUPUNCTURE AND WELLNESS LLC.

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	:	1689213498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-CITIES ACUPUNCTURE AND WELLNESS LLC.

Provider Business Mailing Address
First Line	:	4006 FORT HENRY DR # 2
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-2028
Country	:	US
Telephone Number	:	423-900-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 FORT HENRY DR # 2
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-2028
Country	:	US
Telephone Number	:	423-900-2424
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER /ACUPUNCTURIST
Name	:	SARA COMBS-ROBERT
Credential	:
Telephone Number	:	423-900-2424

Provider Enumeration Date	:	12/26/2019
Last Update Date	:	12/26/2019

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