Provider Demographics
NPI:1164284618
Name:DIVINE ACUPUNCTURE AND WELLNESS LLC
Entity Type:Organization
Organization Name:DIVINE ACUPUNCTURE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROKACH
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:352-603-7763
Mailing Address - Street 1:9479 CR 735
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:FL
Mailing Address - Zip Code:33597-4043
Mailing Address - Country:US
Mailing Address - Phone:352-603-7763
Mailing Address - Fax:
Practice Address - Street 1:109 E JOE P STRICKLAND JR AVE
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-6116
Practice Address - Country:US
Practice Address - Phone:352-603-7763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty