Provider Demographics
NPI:1427431394
Name:XTREME HEALING & ACUPUNCTURE
Entity type:Organization
Organization Name:XTREME HEALING & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, AP, LAC
Authorized Official - Prefix:
Authorized Official - First Name:FRANTZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCLERVIL
Authorized Official - Suffix:
Authorized Official - Credentials:AP, LAC
Authorized Official - Phone:954-297-8196
Mailing Address - Street 1:2787 E OAKLAND PARK BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1643
Mailing Address - Country:US
Mailing Address - Phone:954-297-8196
Mailing Address - Fax:
Practice Address - Street 1:1720 NE 3RD AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-2905
Practice Address - Country:US
Practice Address - Phone:954-297-8196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3042261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care