Provider Demographics
NPI:1699278614
Name:INFINITE SKY ACUPUNCTURE
Entity type:Organization
Organization Name:INFINITE SKY ACUPUNCTURE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:520-886-4089
Mailing Address - Street 1:760 N WOODROSE PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3191
Mailing Address - Country:US
Mailing Address - Phone:520-886-4089
Mailing Address - Fax:
Practice Address - Street 1:760 N WOODROSE PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3191
Practice Address - Country:US
Practice Address - Phone:520-886-4089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1073171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty