Organization
MOON TIDES ACUPUNCTURE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLER YORK LAC, MSTOM (OWNER)
(910) 274-6711
Entity
Organization
Contact information
Practice address
516 PRINCESS ST, WILMINGTON, NC 28401-4131
(910) 367-5747
Mailing address
401 S 5TH AVE UNIT D, WILMINGTON, NC 28401-5187
(910) 274-6711
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629527874
INDIVIDUAL NPI
—
Enumeration date
02/06/2023
Last updated
02/06/2023
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