Provider Demographics
NPI:1023364858
Name:BLUE SERENITY ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:BLUE SERENITY ACUPUNCTURE LLC
Other - Org Name:BLUE SERENITY ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:480-559-9744
Mailing Address - Street 1:16601 N 40TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3345
Mailing Address - Country:US
Mailing Address - Phone:480-559-9744
Mailing Address - Fax:480-559-9784
Practice Address - Street 1:16601 N 40TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3345
Practice Address - Country:US
Practice Address - Phone:480-559-9744
Practice Address - Fax:480-559-9784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty