Provider Demographics
NPI:1770023269
Name:WELL ACUPUNTURE INC
Entity type:Organization
Organization Name:WELL ACUPUNTURE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:POULIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MAC, LMT
Authorized Official - Phone:443-600-4329
Mailing Address - Street 1:42 E CROSS ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4025
Mailing Address - Country:US
Mailing Address - Phone:443-600-4329
Mailing Address - Fax:
Practice Address - Street 1:42 E CROSS ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4025
Practice Address - Country:US
Practice Address - Phone:443-600-4329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty