Provider Demographics
NPI:1386175883
Name:BO ACUPUNCTURE HEALING, LLC
Entity type:Organization
Organization Name:BO ACUPUNCTURE HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:BO
Authorized Official - Middle Name:
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSAC
Authorized Official - Phone:203-305-2141
Mailing Address - Street 1:35 OLD TAVERN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3450
Mailing Address - Country:US
Mailing Address - Phone:203-305-2141
Mailing Address - Fax:
Practice Address - Street 1:35 OLD TAVERN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3450
Practice Address - Country:US
Practice Address - Phone:203-305-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000658171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty