Provider Demographics
NPI:1174189666
Name:GREAT ROAD ACUPUNCTURE AND HERBS LLC
Entity Type:Organization
Organization Name:GREAT ROAD ACUPUNCTURE AND HERBS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:I
Authorized Official - Last Name:STOJANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:978-394-9485
Mailing Address - Street 1:496 HEALD RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1418
Mailing Address - Country:US
Mailing Address - Phone:978-369-4248
Mailing Address - Fax:
Practice Address - Street 1:75 GREAT RD STE 201
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5678
Practice Address - Country:US
Practice Address - Phone:978-277-8099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty