Provider Demographics
NPI:1003322926
Name:MILLENNIUM ACUPUNCTURE
Entity Type:Organization
Organization Name:MILLENNIUM ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:520-551-0451
Mailing Address - Street 1:6161 E PIMA ST TUCSON AZ 85712
Mailing Address - Street 2:APT 2074
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-551-0451
Mailing Address - Fax:
Practice Address - Street 1:6161 E PIMA ST TUCSON AZ 85712
Practice Address - Street 2:APT 2074
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-551-0451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty