Pine Street Clinic LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

1140 Issued in CA

Legal business name

PINE STREET CLINIC LLC

Practice address

124 Pine St
San Anselmo, CA 94960-2602

Phone

(415) 485-0484

NPI assigned

Mar 8, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Broffman, LACNPI 1770920126

Title

Member

Phone

(415) 485-0484

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Broffman, LAC

  • Acupuncturist
  • San Anselmo, CA
  • NPI 1770920126
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1801194303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 PINE ST",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602602",
            "telephone_number": "415-485-0484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 PINE ST",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602602",
            "telephone_number": "415-485-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE STREET CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-08",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "BROFFMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "415-485-0484",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "1140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in San Anselmo, CA
• Providers in San Anselmo, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.