Provider Demographics
NPI:1235375858
Name:SUSQUEHANNA ACUPUNCTURE AND HEALING ARTS CENTER
Entity Type:Organization
Organization Name:SUSQUEHANNA ACUPUNCTURE AND HEALING ARTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUNDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:717-426-3166
Mailing Address - Street 1:44 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-1424
Mailing Address - Country:US
Mailing Address - Phone:717-426-3166
Mailing Address - Fax:
Practice Address - Street 1:44 W MARKET ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-1424
Practice Address - Country:US
Practice Address - Phone:717-426-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000633171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty