Provider Demographics
NPI:1124459128
Name:KONZA ACUPUNCTURE & HERBAL MEDICINE, LLC
Entity type:Organization
Organization Name:KONZA ACUPUNCTURE & HERBAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DIPLOMATE OM
Authorized Official - Phone:785-317-2313
Mailing Address - Street 1:307 PEARL PARKERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66872-9308
Mailing Address - Country:US
Mailing Address - Phone:785-317-2313
Mailing Address - Fax:
Practice Address - Street 1:2749 PEMBROOK PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-7482
Practice Address - Country:US
Practice Address - Phone:785-537-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty