Provider Demographics
NPI:1104671791
Name:COUDRAY ACUPUNCTURE LLC
Entity type:Organization
Organization Name:COUDRAY ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COUDRAY
Authorized Official - Suffix:
Authorized Official - Credentials:AP DIPL AC
Authorized Official - Phone:321-303-5240
Mailing Address - Street 1:2900 E GRAND AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5268
Mailing Address - Country:US
Mailing Address - Phone:321-303-5240
Mailing Address - Fax:321-244-0453
Practice Address - Street 1:2900 E GRAND AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5268
Practice Address - Country:US
Practice Address - Phone:321-303-5240
Practice Address - Fax:321-244-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty