Provider Demographics
NPI:1114460482
Name:THE ROOT CAUSE ACUPUNCTURE, LLLC
Entity Type:Organization
Organization Name:THE ROOT CAUSE ACUPUNCTURE, LLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:817-681-3924
Mailing Address - Street 1:1010 LOCH VAIL UNIT 21
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2669
Mailing Address - Country:US
Mailing Address - Phone:817-681-3924
Mailing Address - Fax:
Practice Address - Street 1:1010 LOCH VAIL UNIT 21
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2669
Practice Address - Country:US
Practice Address - Phone:817-681-3924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty