Provider Demographics
NPI:1386947661
Name:CHINESE ACUPUNCTURE CLINIC, LLC
Entity type:Organization
Organization Name:CHINESE ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEDY
Authorized Official - Middle Name:I
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:512-864-1441
Mailing Address - Street 1:3613 WILLIAMS DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1377
Mailing Address - Country:US
Mailing Address - Phone:512-864-1441
Mailing Address - Fax:800-479-8616
Practice Address - Street 1:3613 WILLIAMS DR
Practice Address - Street 2:SUITE 303
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1377
Practice Address - Country:US
Practice Address - Phone:512-864-1441
Practice Address - Fax:800-479-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXAC1215171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty