Provider Demographics
NPI:1104303460
Name:ESSENCE ACUPUNCTURE AND WELLNESS
Entity type:Organization
Organization Name:ESSENCE ACUPUNCTURE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIVONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-922-0479
Mailing Address - Street 1:7870 BROADWAY ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2583
Mailing Address - Country:US
Mailing Address - Phone:210-236-5862
Mailing Address - Fax:
Practice Address - Street 1:7870 BROADWAY ST BLDG A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2583
Practice Address - Country:US
Practice Address - Phone:210-236-5862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01660171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty