Provider Demographics
NPI:1962711176
Name:CENTRAL ILLINOIS ACUPUNCTURE, INC.
Entity type:Organization
Organization Name:CENTRAL ILLINOIS ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOBIAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DONAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:217-622-4845
Mailing Address - Street 1:313 ASTORIA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1247
Mailing Address - Country:US
Mailing Address - Phone:217-622-4845
Mailing Address - Fax:
Practice Address - Street 1:313 ASTORIA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1247
Practice Address - Country:US
Practice Address - Phone:217-622-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000946171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty