Provider Demographics
NPI:1467860395
Name:BRONSON WELLNESS LLC
Entity type:Organization
Organization Name:BRONSON WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:410-212-4181
Mailing Address - Street 1:1402 DAMSEL LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1258
Mailing Address - Country:US
Mailing Address - Phone:410-212-4181
Mailing Address - Fax:
Practice Address - Street 1:645 RIDGELY AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1069
Practice Address - Country:US
Practice Address - Phone:410-266-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty