Provider Demographics
NPI:1083185151
Name:ANCIENT ART OF HEALING
Entity Type:Organization
Organization Name:ANCIENT ART OF HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:AP-DOM
Authorized Official - Phone:863-644-2447
Mailing Address - Street 1:6700 S FLORIDA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3310
Mailing Address - Country:US
Mailing Address - Phone:863-967-4258
Mailing Address - Fax:
Practice Address - Street 1:6700 S FLORIDA AVE STE 5
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3310
Practice Address - Country:US
Practice Address - Phone:863-967-4258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center