Provider Demographics
NPI:1013553676
Name:SILVER STREAK ACUPUNCTURE
Entity Type:Organization
Organization Name:SILVER STREAK ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY SWADELL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:650-229-3024
Mailing Address - Street 1:1512 SAN CARLOS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2138
Mailing Address - Country:US
Mailing Address - Phone:650-229-3024
Mailing Address - Fax:
Practice Address - Street 1:1512 SAN CARLOS AVE
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2138
Practice Address - Country:US
Practice Address - Phone:650-229-3024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty