Provider Demographics
NPI:1285882548
Name:ACUPUNCTURE CROSSROADS LLC
Entity type:Organization
Organization Name:ACUPUNCTURE CROSSROADS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:321-574-0604
Mailing Address - Street 1:2211 SPRING CREEK CIR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4038
Mailing Address - Country:US
Mailing Address - Phone:321-574-0604
Mailing Address - Fax:
Practice Address - Street 1:2211 SPRING CREEK CIR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4038
Practice Address - Country:US
Practice Address - Phone:321-574-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2529171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty