Provider Demographics
NPI:1275153447
Name:ACUPUNCTURE INSTITUTE
Entity Type:Organization
Organization Name:ACUPUNCTURE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, LAC
Authorized Official - Phone:831-224-7621
Mailing Address - Street 1:859 UNIVERSITY AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-7616
Mailing Address - Country:US
Mailing Address - Phone:831-224-7621
Mailing Address - Fax:
Practice Address - Street 1:859 UNIVERSITY AVE APT 7
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7616
Practice Address - Country:US
Practice Address - Phone:831-224-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396041919Medicaid