Provider Demographics
NPI:1043451933
Name:ACUPUNCTURE WELLNESS CENTER OF CORAL SPRINGS P.A.
Entity Type:Organization
Organization Name:ACUPUNCTURE WELLNESS CENTER OF CORAL SPRINGS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBOL
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-755-1292
Mailing Address - Street 1:10139 NW 31ST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3908
Mailing Address - Country:US
Mailing Address - Phone:954-755-1292
Mailing Address - Fax:954-755-4029
Practice Address - Street 1:10139 NW 31ST ST STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3908
Practice Address - Country:US
Practice Address - Phone:954-755-1292
Practice Address - Fax:954-755-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty