Provider Demographics
NPI:1306145529
Name:GOOD MEDICINE ACUPUNCTURE SERVICES, LLC
Entity type:Organization
Organization Name:GOOD MEDICINE ACUPUNCTURE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:239-826-8535
Mailing Address - Street 1:7051 CYPRESS TER
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8822
Mailing Address - Country:US
Mailing Address - Phone:239-826-8535
Mailing Address - Fax:
Practice Address - Street 1:7051 CYPRESS TER
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8822
Practice Address - Country:US
Practice Address - Phone:239-826-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2844171100000X
FLAP2906171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty