Provider Demographics
NPI:1033549530
Name:WELLSPRING ACUPUNCTURE
Entity Type:Organization
Organization Name:WELLSPRING ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEREN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-827-5375
Mailing Address - Street 1:5 WEATHERLY DR APT 209
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3287
Mailing Address - Country:US
Mailing Address - Phone:415-968-9294
Mailing Address - Fax:
Practice Address - Street 1:45 CAMINO ALTO STE 204
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2935
Practice Address - Country:US
Practice Address - Phone:415-968-9294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15234171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty