Provider Demographics
NPI:1073026183
Name:DAO WELLNESS & ACUPUNCTURE CENTER, A PROF. ORG.
Entity Type:Organization
Organization Name:DAO WELLNESS & ACUPUNCTURE CENTER, A PROF. ORG.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / CHIEF ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:REISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, CMT, MTCM
Authorized Official - Phone:408-766-1811
Mailing Address - Street 1:6055 MERIDIAN AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2700
Mailing Address - Country:US
Mailing Address - Phone:408-766-1811
Mailing Address - Fax:408-550-7112
Practice Address - Street 1:6055 MERIDIAN AVE STE 30
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2700
Practice Address - Country:US
Practice Address - Phone:408-766-1811
Practice Address - Fax:408-550-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA16628171100000X
CA54384225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty