MEDICARE: ACUPUNCTURE PAIN RELIEF CLINIC 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	:	1902365158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUPUNCTURE PAIN RELIEF CLINIC LLC

Provider Business Mailing Address
First Line	:	827 N BLOODWORTH ST STE A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1231
Country	:	US
Telephone Number	:	919-283-8784
Fax Number	:	855-854-7098

Provider Business Practice Location Address
First Line	:	827 N BLOODWORTH ST STE A
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1231
Country	:	US
Telephone Number	:	919-283-8784
Fax Number	:	855-854-7098

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	JACOB LEE
Credential	:	LAC
Telephone Number	:	919-283-8784

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	12/11/2019

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