Provider Demographics
NPI:1225453186
Name:ACUPUNCTURE CARE MEDWAY
Entity Type:Organization
Organization Name:ACUPUNCTURE CARE MEDWAY
Other - Org Name:BOSTON KUNG FU TAI CHI INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:LICAC
Authorized Official - Phone:508-533-1234
Mailing Address - Street 1:16 CAUSEWAY ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-2420
Mailing Address - Country:US
Mailing Address - Phone:508-533-1234
Mailing Address - Fax:
Practice Address - Street 1:16 CAUSEWAY ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-2420
Practice Address - Country:US
Practice Address - Phone:508-533-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1063581023OtherNPI