Provider Demographics
NPI:1003158940
Name:ISTHMUS ACUPUNCTURE CENTER, LLC
Entity Type:Organization
Organization Name:ISTHMUS ACUPUNCTURE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SUZY
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:608-441-9355
Mailing Address - Street 1:890 W WINGRA DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1942
Mailing Address - Country:US
Mailing Address - Phone:608-441-9355
Mailing Address - Fax:608-441-9395
Practice Address - Street 1:890 W WINGRA DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1942
Practice Address - Country:US
Practice Address - Phone:608-441-9355
Practice Address - Fax:608-441-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI328-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty