Provider Demographics
NPI:1588939698
Name:WELLNESS ACUPUNCTURE CLINIC INC
Entity type:Organization
Organization Name:WELLNESS ACUPUNCTURE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:IL WOO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-241-0193
Mailing Address - Street 1:2257 ROYAL LN
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-7819
Mailing Address - Country:US
Mailing Address - Phone:972-241-0193
Mailing Address - Fax:972-241-0193
Practice Address - Street 1:2257 ROYAL LN
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-7819
Practice Address - Country:US
Practice Address - Phone:972-241-0193
Practice Address - Fax:972-241-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01318171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty