Provider Demographics
NPI:1912727116
Name:BEAR AND ROOT ACUPUNCTURE AND HERBAL MEDICINE INC.
Entity type:Organization
Organization Name:BEAR AND ROOT ACUPUNCTURE AND HERBAL MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:661-303-3362
Mailing Address - Street 1:15 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-2632
Mailing Address - Country:US
Mailing Address - Phone:661-303-3362
Mailing Address - Fax:
Practice Address - Street 1:15 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2632
Practice Address - Country:US
Practice Address - Phone:661-303-3362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty