Provider Demographics
NPI:1194123166
Name:MODERN FAMILIY ACUPUNCTURE AND HOLISTICE MEDICINE CLINIC,LLC
Entity type:Organization
Organization Name:MODERN FAMILIY ACUPUNCTURE AND HOLISTICE MEDICINE CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:SENKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-904-5700
Mailing Address - Street 1:165 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 E PARK AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1678
Practice Address - Country:US
Practice Address - Phone:920-904-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty