Provider Demographics
NPI:1316062680
Name:YAKIMA ACUPUNCTURE CLINIC
Entity type:Organization
Organization Name:YAKIMA ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC MAC DIPL ACUP
Authorized Official - Phone:509-965-6751
Mailing Address - Street 1:3905 SUMMITVIEW AVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902
Mailing Address - Country:US
Mailing Address - Phone:509-965-6751
Mailing Address - Fax:509-965-9868
Practice Address - Street 1:3905 SUMMITVIEW AVE SUITE 200
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-965-6751
Practice Address - Fax:509-965-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000296171100000X
WAAC00002606171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty