Provider Demographics
NPI:1033483938
Name:ALIVE AND WELL ACUPUNCTURE CLINIC, INC.
Entity Type:Organization
Organization Name:ALIVE AND WELL ACUPUNCTURE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LAP
Authorized Official - Phone:561-272-7816
Mailing Address - Street 1:255 GEORGE BUSH BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-4063
Mailing Address - Country:US
Mailing Address - Phone:561-272-7816
Mailing Address - Fax:561-272-7566
Practice Address - Street 1:255 GEORGE BUSH BLVD
Practice Address - Street 2:STE. B
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-4063
Practice Address - Country:US
Practice Address - Phone:561-272-7816
Practice Address - Fax:561-272-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL439171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty