Provider Demographics
NPI:1104391242
Name:DR NA ACUCHIRO TMJ CLINIC, INC
Entity Type:Organization
Organization Name:DR NA ACUCHIRO TMJ CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:323-766-1600
Mailing Address - Street 1:955 S WESTERN AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1006
Mailing Address - Country:US
Mailing Address - Phone:323-766-1600
Mailing Address - Fax:323-766-1660
Practice Address - Street 1:955 S WESTERN AVE STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1006
Practice Address - Country:US
Practice Address - Phone:323-766-1600
Practice Address - Fax:323-766-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty