Provider Demographics
NPI:1245785526
Name:HOLISTIC ANIMAL CLINIC
Entity Type:Organization
Organization Name:HOLISTIC ANIMAL CLINIC
Other - Org Name:GRAHAM QUIGLEY, L.AC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:510-912-8184
Mailing Address - Street 1:2929 SUMMIT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3423
Mailing Address - Country:US
Mailing Address - Phone:510-912-8184
Mailing Address - Fax:510-788-6438
Practice Address - Street 1:2929 SUMMIT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3423
Practice Address - Country:US
Practice Address - Phone:510-912-8184
Practice Address - Fax:510-788-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14976171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740534569OtherNPI FOR MYSELF, INDIVIDUAL AND OWNER