Provider Demographics
NPI:1124598727
Name:LONNIE ASCHEBROOK ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:LONNIE ASCHEBROOK ACUPUNCTURE LLC
Other - Org Name:LAKE NONA WELLNESS CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:ASCHEBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, DIPL OM, LAC
Authorized Official - Phone:901-376-5198
Mailing Address - Street 1:9246 REYMONT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-3814
Mailing Address - Country:US
Mailing Address - Phone:901-376-5198
Mailing Address - Fax:
Practice Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7593
Practice Address - Country:US
Practice Address - Phone:901-376-5198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty