Provider Demographics
NPI:1215181581
Name:ACU CARE ACUPUNCTURE CLINIC, INC
Entity Type:Organization
Organization Name:ACU CARE ACUPUNCTURE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WYLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, L AC,
Authorized Official - Phone:915-585-6222
Mailing Address - Street 1:6633 N MESA ST STE 507
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4422
Mailing Address - Country:US
Mailing Address - Phone:915-585-6222
Mailing Address - Fax:915-585-6230
Practice Address - Street 1:6633 N MESA ST STE 507
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4422
Practice Address - Country:US
Practice Address - Phone:915-585-6222
Practice Address - Fax:915-585-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00461171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty