Provider Demographics
NPI:1306022207
Name:ACUPUNCTURE MEDICAL
Entity Type:Organization
Organization Name:ACUPUNCTURE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, LICAC
Authorized Official - Phone:713-942-9688
Mailing Address - Street 1:716 CHELSEA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-6206
Mailing Address - Country:US
Mailing Address - Phone:713-942-9688
Mailing Address - Fax:713-942-9335
Practice Address - Street 1:716 CHELSEA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6206
Practice Address - Country:US
Practice Address - Phone:713-942-9688
Practice Address - Fax:713-942-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00410171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029LQOtherBLUE CROSS