Provider Demographics
NPI:1346056173
Name:FIRELIGHT ACUPUNCTURE LLC
Entity type:Organization
Organization Name:FIRELIGHT ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:POTTER
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MAC, MS, MA
Authorized Official - Phone:207-838-7010
Mailing Address - Street 1:17 GERRY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5745
Mailing Address - Country:US
Mailing Address - Phone:207-838-7010
Mailing Address - Fax:
Practice Address - Street 1:84 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-3261
Practice Address - Country:US
Practice Address - Phone:207-838-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty