Provider Demographics
NPI:1528669595
Name:LUST FOR LIFE ACUPUNCTURE LLC
Entity type:Organization
Organization Name:LUST FOR LIFE ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:443-293-2085
Mailing Address - Street 1:7721 GAITHER RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7101
Mailing Address - Country:US
Mailing Address - Phone:443-293-2085
Mailing Address - Fax:
Practice Address - Street 1:525 OLD WESTMINSTER PIKE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6268
Practice Address - Country:US
Practice Address - Phone:443-293-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty