Provider Demographics
NPI:1164002960
Name:BLC ACUPUNCTURE & INTEGRATIVE MEDICINE, PLLC
Entity Type:Organization
Organization Name:BLC ACUPUNCTURE & INTEGRATIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-547-7797
Mailing Address - Street 1:1210 COTTONWOOD CREEK TRL.
Mailing Address - Street 2:SUITE #325
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-986-4289
Mailing Address - Fax:
Practice Address - Street 1:1210 COTTONWOOD CREEK TRL.
Practice Address - Street 2:SUITE #325
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-547-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center