Individual
JAMES WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC, LMT
Contact information
Practice address
80 VINCENT RD, HICKSVILLE, NY 11801-1927
(646) 220-3133
Mailing address
80 VINCENT RD, HICKSVILLE, NY 11801-1927
(646) 220-3133
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
004890
NY
Other
Enumeration date
10/05/2014
Last updated
10/05/2014
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