Provider Demographics
NPI:1194240176
Name:BRADENTON COMMUNITY ACUPUNCTURE
Entity type:Organization
Organization Name:BRADENTON COMMUNITY ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-720-1485
Mailing Address - Street 1:5245 OFFICE PARK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3444
Mailing Address - Country:US
Mailing Address - Phone:941-720-1485
Mailing Address - Fax:
Practice Address - Street 1:5245 OFFICE PARK BLVD SUITE 103
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-720-1485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2365171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty