Provider Demographics
NPI:1174833958
Name:PACIFIC GROVE ACUPUNCTURE
Entity Type:Organization
Organization Name:PACIFIC GROVE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, HERBALIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:831-224-7621
Mailing Address - Street 1:150 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2735
Mailing Address - Country:US
Mailing Address - Phone:831-224-7621
Mailing Address - Fax:
Practice Address - Street 1:150 15TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2735
Practice Address - Country:US
Practice Address - Phone:831-224-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13829171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty