MEDICARE: THREE TREASURES ORIENTAL 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	AP3296	FL

General Provider Information

NPI Number	:	1801288907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE TREASURES ORIENTAL MEDICINE

Provider Business Mailing Address
First Line	:	3591 SW 146TH TER
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3737
Country	:	US
Telephone Number	:	305-790-2374
Fax Number	:	954-450-4004

Provider Business Practice Location Address
First Line	:	3591 SW 146TH TER
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3737
Country	:	US
Telephone Number	:	305-790-2374
Fax Number	:	954-450-4004

Authorized Official
Title or Position	:	DOM
Name	:	DR. SHONTIA JOHNSON
Credential	:	L.AC
Telephone Number	:	305-790-2374

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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