Provider Demographics
NPI:1336396712
Name:INTEGRATED ACUPUNCTURE SERVICES, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:INTEGRATED ACUPUNCTURE SERVICES, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MEES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC DAOM
Authorized Official - Phone:805-705-1792
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-0757
Mailing Address - Country:US
Mailing Address - Phone:805-705-1792
Mailing Address - Fax:805-705-1792
Practice Address - Street 1:6639A BAY LAUREL PL
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-3504
Practice Address - Country:US
Practice Address - Phone:805-705-1792
Practice Address - Fax:805-705-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8417261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service