Provider Demographics
NPI:1992988083
Name:ACUPUNCTURE AND HERBAL MEDICINE LLC
Entity type:Organization
Organization Name:ACUPUNCTURE AND HERBAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:813-659-2502
Mailing Address - Street 1:122 FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7018
Mailing Address - Country:US
Mailing Address - Phone:813-659-2502
Mailing Address - Fax:
Practice Address - Street 1:122 FAULKNER ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7018
Practice Address - Country:US
Practice Address - Phone:813-659-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty