Provider Demographics
NPI:1003178047
Name:MIA ACUPUNCTURE, LLC
Entity Type:Organization
Organization Name:MIA ACUPUNCTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:KASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAP, DOM
Authorized Official - Phone:305-606-8901
Mailing Address - Street 1:9801 COLLINS AVE APT 14I
Mailing Address - Street 2:
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1840
Mailing Address - Country:US
Mailing Address - Phone:305-606-8901
Mailing Address - Fax:
Practice Address - Street 1:1100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4432
Practice Address - Country:US
Practice Address - Phone:954-456-6945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2904171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty