Provider Demographics
NPI:1992125645
Name:SHALOM ACUPUNCTURE & HERBS CLINIC
Entity type:Organization
Organization Name:SHALOM ACUPUNCTURE & HERBS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURE LIST
Authorized Official - Phone:256-585-2661
Mailing Address - Street 1:6954 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1368
Mailing Address - Country:US
Mailing Address - Phone:334-301-8860
Mailing Address - Fax:334-512-9979
Practice Address - Street 1:6954 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1368
Practice Address - Country:US
Practice Address - Phone:334-301-8860
Practice Address - Fax:334-512-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3556171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty