Organization
ELEMENTAL THERAPIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANYA PEACOCK TRAVIS LAC (OWNER)
(843) 810-9731
Entity
Organization
Contact information
Practice address
3030 ASHLEY TOWN CENTER DR, CHARLESTON, SC 29414-5664
(843) 810-9731
Mailing address
3165 COLD HARBOR WAY, CHARLESTON, SC 29414-8082
(843) 810-9731
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
128
SC
Other
Enumeration date
12/16/2011
Last updated
12/16/2011
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