Provider Demographics
NPI:1275036113
Name:MACUPUNCTURE
Entity Type:Organization
Organization Name:MACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIVOR
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:407-978-0997
Mailing Address - Street 1:222 W YAMATO RD STE 106-169
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4704
Mailing Address - Country:US
Mailing Address - Phone:407-978-0997
Mailing Address - Fax:
Practice Address - Street 1:222 W YAMATO RD STE 106-169
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4704
Practice Address - Country:US
Practice Address - Phone:407-978-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1840171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty