Provider Demographics
NPI:1184227225
Name:PANDA ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:PANDA ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRIMARY PRACTICIONER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, L AC
Authorized Official - Phone:614-354-9101
Mailing Address - Street 1:1511 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1832
Mailing Address - Country:US
Mailing Address - Phone:614-354-9101
Mailing Address - Fax:
Practice Address - Street 1:1511 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1832
Practice Address - Country:US
Practice Address - Phone:614-354-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center